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Scott Benner 0:00
This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. The pen is America's only FDA cleared smart insulin pen and app system. In pen works like other pens, it's just a lot smarter, you can use it in pen, like any other injector pen. The difference in pen is that it tracks each dose and delivers your data to a secure app on your smartphone. So finally, there's no complicated math and no log book to update. I urge you to go to companion medical comm or click on the links in the show notes are the ones that are available at Juicebox podcast.com.
Welcome to Ask Scott and Jenny. In today's episode, I Scott and Jenny Jenny Smith from the diabetes pro tip series in defining diabetes, you know Jenny, Jenny works at integrated diabetes. She's a CDE, a registered pump trainer CGM trainer dietician, she has type one, if Jenny caught a foul ball at a baseball game, she'd give it to your kid. Today, Jenny and I are going to talk about the importance of hydration. And we're going to have an extended conversation about the impact that blood sugars have one function mood, and just living with Type One Diabetes, it becomes a really longer conversation than I expected it to. But we're not just going to talk about how low blood sugars make you feel, but maybe why they make you feel that way. As well as highs, then I'll kind of tell a story about art and seizure and actually cover something in my own health. It's comprehensive already. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. or becoming bold with insulin.
Unknown Speaker 2:10
I'm gonna ask my question.
Scott Benner 2:13
Yeah. So Arden started school up last week. And first two days were great, you know, and then there was the weekend and then Monday came. And her blood sugar went up to like 140. I couldn't get it back down. Then she ate and I couldn't get it under 180. And then it sat there and sat there and sat down is like, Huh, what's going on? And tried everything that you would think of? Until they landed on the answer. And the answer was, Arden gets up in the morning. She leaves for school gardens, not a breakfast person. Not when she goes to school. She is on the weekends, but not when she goes to school. So she'll run out the door. She goes to school, sometimes breakfast, or sometimes they she has lunch this year, two different times 1030 and 12 o'clock. So every other day it changes just to make things fun. Yeah, right. So here's what ended up being the issue. Arden was dehydrated. I stuck a bottle of water in front of Arden and I was like drink the water. She takes a little sip of it. Like a demure princess at a tea party. And I'm like no no, no slug the water back. Now like I need you to get a half a bottle of this water in right now. So she complained and bemoan This is not what it is. Leave me alone, blah, blah, blah. She didn't do it didn't do it. Blood Sugar climbs and climbs and climbs, we're bolusing nothing's happening. I finally she starts getting a little surly because her blood sugar's higher. And I get more direct and I'm like, Look, drink the water. Or, you know, I'm gonna kick you out of the house. I forget. I forget what I said. But I you know, I was just like more direct about it. So she bangs this water in. And 10 minutes later, diagonal down arrow and here comes her blood sugar down and levels out and we're good. The next day she gets up for school. She doesn't drink water, her blood sugar's difficult. As soon as I get her to push water, it's now all the sudden, the pump does what I expect it to I don't know if you know that phrase or people listening have that idea. Like I always think of it like, is the infusion site acting the way I expect. That's one of the ways I kind of inspect the infusion site, in my mind is exactly what I think it should be doing. And this was the same thing. That's why I was like, Oh, God, is it the infusion site? Is it you know, you know, people start going through? Yeah, Moon out of phase like, you know, you start to start running through these litany of things that are probably not at the core of what's going on. Anyway, that's it, it was dehydration, but I really would like you to talk about that a little bit because I think it is. I think a lot of people are not hydrated properly. And I think we spend a lot of time chasing blood sugar's around that might be fixed with a bottle of water.
Jennifer Smith, CDE 4:54
That's a great, great one to bring up and I I in fact, I just I just had a conversation with a mother of an athlete who I specifically addressed the hydration component with. Also around like CGM and to you know CGM is remembers CGM or reading interstitial glucose, not reading blood glucose from your bloodstream. It's reading your interstitial glucose, which means that hydration makes a difference for how well the CGM is giving you data. Same thing for hydration in the body and influence flow and insulin action and movement and everything. You know, if you think about, we all wake up dehydrated. Unless you are somebody who drinks water through the night, you know, every time you get up to pee or whatever. 99% of people wake up dehydrated in the morning. That's why
Scott Benner 5:51
I weigh myself in the morning.
Jennifer Smith, CDE 5:54
Yes, exactly. Call the driveway. Absolutely. driveway dehydrated with no clothes on is the best time to wait yourself. There's another little
Scott Benner 6:04
tidbit to get my arms trying to make like maybe this will get me off the ground a little bit.
Unknown Speaker 6:12
That I that is a really humorous
Scott Benner 6:15
mix of you're just imagining that I'm actually flipping.
Jennifer Smith, CDE 6:19
But yeah, hydration. In fact, it's a it's a trick that I came across myself. In starting to do like workouts in the morning. Knowing that I was dehydrated, I was drinking some water before I would head to the gym and I was like, Huh, blood sugar, even on mornings that I wasn't then going to the gym, and I was drinking my big slug glass of water, you know, like probably it was probably at least 12 ounce glass of water in the morning when I got up. I didn't have that weird, dramatic change in blood sugar, I didn't have the problems post meal that I you know, was trying to beat down with extra insulin before. And hydration is huge. If you drink the big thing of water when you wake up in the morning. Oftentimes, not only does it wake up your digestive system, without a carb component being there to cause a significant rise. But you're also adding hydration to a system that needs it. Your insulin can work better, it can flow better, you've got better circulation.
Scott Benner 7:23
Yeah, it's one of those situations where you can see yourself as diabetes, when you should still be thinking about yourself as person two. And I just gave privately advice to somebody who said they were fighting with what they you know, they were calling it the dawn phenomenon. That's what anybody calls any blood sugar between 4am and 8am that they don't like I guess the dawn phenomenon, like you've no idea, but if it is or not. Okay. And so my we talked through this guy's problem, and I said, I'll tell you what, for about a week, why don't you put a glass of water at your bedside. And when you open up your eyes, just bang it back. And it's my son gets up early in the morning to play baseball, and I tell them all the time, like hydrate yourself right away, it wakes your brain up. It you know, while it does so many things for you. And one of them are a lot of them are the things Jenny just said. And, you know, I started off by talking about how it could stop insulin from doing what you expect. But Jenny makes a great point. And Dexcom would be the first to tell you if you're not if you're not hydrated, your CGM might not work correctly. And maybe so maybe that even goes back to Melissa's question. I don't know. I don't know how well Melissa drinks water.
Jennifer Smith, CDE 8:32
It could be pieces of a lot of Yeah, absolutely. I you know, hydration, even just from that standpoint of overall health. If you think about you know being dehydrated is like having like molasses in January running through your blood running through your system, right? If you think of all the things that are supposed to be circulating in your body, in your bloodstream, all the nutrients and the wonderful things that are supposed to get to certain parts to heal and rebuild and restructure the body and keep you running healthy. If you've got like mud running in your system, think how hard it is to heal and repair your body. Yes,
Scott Benner 9:11
yep, there we go. I fixed all your problems. Have a glass of water.
Jennifer Smith, CDE 9:17
Drink your water to the finish. I agree. Yeah. That my kids don't know anything. Honestly, they're they're excited when they get to have like a glass of juice at grandma's house because they only know water. That's, that's all they drink. They're like
Unknown Speaker 9:32
this is amazing.
Jennifer Smith, CDE 9:35
Like, what is this mom? I'm like this is called juice. Yeah. No.
Unknown Speaker 9:40
But it's amazing is that you enjoy it. That's why
Scott Benner 9:42
grandma's great. And that's that. I have one here. I have one here from Rebecca. And you She asked if you could explain the biology behind blood sugar changes in relation to mood. So the actual biology of it. I mean, I think it's I think it's Something we all recognize, right? Like, the simple one to point out is, if your blood sugar gets too low, you know, I've heard stories that are, that are, are massively sad, you know, from adults, you know, a spouse of a man, especially whose blood sugar gets low and they're still as strong as they were, but now they don't know what they're doing. And they can get, you know, violent even sometimes if your blood sugar's low enough, you know, besides, you know, the ones we know you can get dizzy, lightheaded, sweaty, you know, there's these things that happen. Those are the obvious ones I don't think we talk enough about and I tried to make a point about them on the podcast, because I think a lot of parents don't. I don't think a lot of parents lend enough credence to the idea that their kids are acting like jerks, but but you know, you're also you know, their blood sugar has been 250 for a week. But can you do it? Do you know? Like, can you speak to it on a on a biological level?
Jennifer Smith, CDE 10:54
On a biological level? And I don't know if she's asking if she's asking, like, the biology behind how you feel when blood sugar is too high or too low, or the biology behind? What stress and mood due to blood sugar?
Scott Benner 11:14
Well, I think here's what I took out of it. Wow, Rebecca, we've got three different questions out of your question. Here's what I always want to know, we'll start with me because you know, it's my podcast. So let's go with what I want to know first, what is God? What happens in the brain, like, so when you're low, I realized there's less blood or less sugar in your blood, and that sugar is sort of the energy your brain works off of right? So why do you start losing functionality when it gets lower? And it's not even a diabetes? Question? Really?
Jennifer Smith, CDE 11:45
Yes, I mean, from a I mean, from just basic physiology, your brain does it. It works off of Google's or, you know, sugar, so we have to make sure that we're maintaining his base level, so that our brain can send out all the signals and perform the way that it's meant to essentially that we're thinking about the way that we're supposed to think as a normal human being. If there's not enough glucose there in the brain is deprived. And so it's almost like, almost like the effect of alcohol on the brain. Right? You sort of get this like loopy, inability to put thoughts together, sometimes not very cohesive language that comes out. And you might be talking about very weird things. And people are like, Oh, that's totally not what we're talking about. Are you okay? You know, so when the brain isn't getting that sugar energy that it needs, if it can't perform, it's doing the best that it can. And it's almost like the signals of just are not connecting quite the right way. Or, and that can lead to some mood components. There are many people who have said, especially when I used to work clinically, in patient, there are some older people with type two, who would come in am I, my husband gets belligerent when he has got these low blood sugars. And he tries to throw the jars at me from the kitchen and whatever. And I'd be like, well, don't get too angry at him. One is not thinking clearly, this is what happens with a low blood sugar. You know, these are the ways to prevent it, blah, blah, blah. But that's pretty normal. Some people do have like this brute strength, they get violent when blood sugar gets so low. And again, from a from a true physiology, I don't know all of the real reasons that that happens, other than the fact that the brain is just not getting what it needs. And it It can't think the right way, I have
Scott Benner 13:49
one thing to add. And I have a theory which is based in nothing. But my thing to add is that Arden had a seizure from too much insulin when she was two right after she was diagnosed, like I gave her too much insulin, she had a seizure. And one day, we were talking about it in the kitchen, and I had a video camera out for a completely different reason. And I just pushed record on it. And let her tell me about the the seizure. It's on YouTube, and a lot of people have watched it but a point she says that she sounded like a monster. And she's too and she said she saw colors. And so her eyes didn't work. I saw colors and then they were back or something like that she talked to so she lost her sight during it. I saw it happen because I reached out to put my hand on her and me touching her scared the crap out of her. You were there. I didn't know I was there anymore. And she says she sounded like a monster because she couldn't talk. She was growling. So in her voice, you can hear it in this video. She's like, I couldn't talk. I sounded like a monster. So she was grunting. It was really something in Iowa. wondered, is that your body? saying? Is it confused? Like you're saying like things are just going haywire and I'm about to short circuit and shut off? Or is it shutting down unnecessary systems trying to keep you alive for right? Because it can it's just trying to do your basic function stuff and keep you alive? Like I don't know the answer, but in the in that space has got to be the answer somewhere. Mm hmm. So, yeah. Now that I bummed everybody out, going, by the way, she was fine, but put glucose in her cheek and she woke right up. It was really not that much trouble. I tried Chinese food before I knew what I was doing. I'm better now. High blood sugars though. Cause so I just talked about it. I don't know if it'll make it into this episode or not. But Arden was really dehydrated, her blood sugar got high. And then she got combative. I was like, the more I asked her to drink a bottle of water. By the time our blood sugar was up in the high two hundreds. She was you know, a million with you asking her to drink that water is like I told her to get up fly across the room. And you know, and she was like, I can't do that. You can't it's right there. Just drink it. You know, she flew. Now, I'll tell you the amazing part is she drank the water, her blood sugar came down. We talked again, 45 minutes later, and her personality was right back again. Yeah, why does that even though
Jennifer Smith, CDE 16:18
I mean I, again, everybody's symptoms, and what comes out of them high or low are a little bit different person to person. But from the high standpoint, it's kind of similar highs. And kind of almost what we talked about with the hydration component. There's this like, slog of like mud and muck kind of gunking. Up there, right? There's way too much glucose, so many people complain about, like the fatigue and inability to, like really put the thoughts together and the fatigue component being different than, like, gosh, I just didn't sleep very well. Last night fatigue. The fatigue is an all encompassing mental fatigue, and it feels like your body is weighed down by bricks, and you're trying to walk through mud. That's high.
Scott Benner 17:19
Do you know at all if you stay high, we all know if you stay high long enough, your body tries to get a client listen to it. Does that go away eventually? That like? Or is it is it just a level of effort that you're used to living with?
Jennifer Smith, CDE 17:34
I would say the ladder it's a level of feeling that you get used to living which with which is why many times if people have been living high, and they bring blood sugars down or bring them down too quickly. They can actually have low blood sugars, simple, low blood sugar symptoms at a more normal value until their body again gets accustomed to that more normal value. And they realize then, well, gosh, I feel better. I'm performing better my test results. If I'm a kid, I'm performing better in school, I'm learning better. It doesn't take me three hours to study two math problems I can get through it like this. So there is you know, a deaf a definite difference there. But from from the mood standpoint, you you would be very cranky to if you had this sort of like sluggish. I just why are you bugging me go away, stop bugging me kind of
Scott Benner 18:37
hard to react it.
Unknown Speaker 18:38
Yeah.
Scott Benner 18:40
I've said this a couple of times in the podcast. And I don't know how comfortable people are when I get really emotional and talk very seriously. But I think that one of the reasons I love making this podcast is because I think everyone deserves to be who they authentically would be if they're not being impacted by low or high blood sugars, or variable swings, or any of the things Jenny just explained. So you know, I mean, think about it like that, when you're struggling to figure out how to make a bolus or how to you know where to do Temp Basal. The end result for you is going to be like this person like who they would have gotten to be if they didn't have diabetes and their blood sugar's bouncing all over the place like you owe that to yourself and, and to the people you love is and try your as hard as you can to get to that spot. It's just it's it's unfair to think like a, you know, I talk to people sometimes who are adults, and there's a one that always pops into my head. It's this woman in her late 30s. And she's a single mother of a lot of children. She told me her eight one sees her over 12 years. And I helped her and she got her blood sugar's down in range and very quickly and as happy as she was to see it happen. You could see how devastating it was to her that it was that easy, and that she had lived all that time and you could hear When she was talking to me, that she was beginning to wonder, like, what did I miss in my life that I don't even know, I missed, you know? And so I don't
Jennifer Smith, CDE 20:08
and are some of the mood component if she's got many children that she's managing on her own? What did she Miss in being able, like different communication method or different way of working with and through problems with her kids and addressing things, and even helping them learn and all of those things, you know, along the way, and I mean, now she can thankfully go forward and do what she wants to do and feel good about it and feel good doing it, you know, but
Scott Benner 20:37
I don't talk about my own health on here very often, but I, for some reason, don't retain iron. So a couple of times in my life, I have my irons gotten very low. The last time it happened was in 2019. So you know, you go to a doctor, and you try a new doctor, you think, well, the last time this happened, like I was just like, gave me a bunch of supplements, I never really felt like I bounced back, you know? So I try, I'll try a different doctor. So of course, anyone who knows anything about low iron, the first thing he thinks when he sees my low iron is so you have cancer, because obviously, you're bleeding internally somewhere and we can't see it. So the guy's face changes. And I'm looking at like, in the logs. I'm like, man, I don't have cancer man. Like, I know, I know what you're thinking and all but this happens to me. Can we just get past it? Well, he goes through all the steps. And those steps take months, he wants to do a capsule study of my esophagus, I have to get scoped from both sides, right. That was fun hormones, and drugs. Oh. So I got scope from both sides. I had to swallow a camera. I had to stop eating corn.
Unknown Speaker 21:45
And gluten.
Scott Benner 21:48
None of those things had any impact on my iron, by the way, actually, there's not even the corn and gluten actually made my iron go down. So now they ruled everything out. And I said the whole time. I'm just I'm like, Look, can you just like get a bag of iron and hang it on an IV and jam it in me? Like, that'd be great, you know? Oh, yeah, we'll do that at the end. If none of this other stuff calls, I could never figure out why they wouldn't do it then. So I over this six month period of getting all these tests done, I'm declining, like really looking bad, starting to gain weight for no reasons. And it turns out after I got two bags of iron Finally, and I'm back to my own peppy, happy self. I was and I'm gonna have to bleep this out. I apparently was quite an at around my house. And so I had no ability to like, handle anything. Like Like, if something got annoyed, I was at 100 if I was mad, I was mad if like, you know, if you were irritated me, I was completely irritated. I had no ability that who would even know this, right? And so I was I was terrible. I'm telling you, they put that iron in. And it was back to you back to myself right now. Now, here's the problem. And the reason I bring this up, even though my family knows that, intellectually, it didn't stop them from having to live through it. Of me just being unpleasant. And I think that that's something to keep in mind too in extended families, like with diabetes to have blood drawn, always lower, always high. Even though you know cognitively Oh, it's because of their blood sugar. It doesn't mean that you don't feel it the same. Like you
Unknown Speaker 23:24
know, like it could handle it.
Scott Benner 23:27
Yeah, it could mess with it with your relationship. So yeah, all the time. I tell you, it's far easier to stay in range and all the good things that come with it. I think this is another good thing that comes with it. I think you get to be yourself and get to have the relationships you are going to have then you can just hate each other for the right reasons.
Jennifer Smith, CDE 23:45
Right? Absolutely. You can be angry because of spilled milk because it really is spilled milk. Yeah,
Unknown Speaker 23:51
but at least you'll be
Scott Benner 23:53
released. You'll hate them for the right reason. Damn it, there'll be clarity. Right? That's all right, exactly. That's fun, Jenny.
Jennifer Smith, CDE 24:02
Iron you. Do you get enough vitamin C?
Scott Benner 24:05
I believe I do. Although By the way, now that I stopped they made me stop eating gluten and corn. I was just like, huh that's cool. Now I have a hard time eating food anymore. Like I'm almost a vegan. I'll tell you what stopped me from being a vegan. I don't like vegetables. But I seriously like now my body doesn't even like i don't know i don't i don't do that well with like meats and proteins anymore. Like I'm just an easier when I'm not eating. I did a baked potato fast one time. I've never been happier.
Unknown Speaker 24:38
Just eat bacon.
Scott Benner 24:40
I was thin as I'd ever been nice. I felt great. some wonderful. It has all the vitamins and nutrients I needed anyway. I don't know what happened.
Jennifer Smith, CDE 24:47
Well, I've never heard of. I'll tell you about it privately. Never heard of the big potato fast. Yeah, that's okay.
Scott Benner 24:54
huge thank you to in Penn for sponsoring this episode of Ask Scott and Jenny Check them out at companion medical comm if you're an MDI user looking for a smarter insulin pen, or you're just a person who you know, doesn't want to pump, this is the way to go in pen. Rox companion medical.com. If you'd like to see the in pen in action, you can see it and Fiona Wilds hands a lot. At her Instagram page, it's Fiona fo na underscore wild w YLD. Go check her out. At the end of this, I'm going to put in the audio from that YouTube video I told you about about art and describing her t shirt. It's a little noisy. So you can try it. If you don't like it, skip out on it. And then you can maybe find it on YouTube. But uh, I just thought I'd put it here in case you're interested. But it's old audio from like an old video camera. So, you know, let's not expect the clarity that you're getting right now in my voice.
Are you talking about when your blood sugar gets low? Like you weren't able to talk? Right? And then what happened? Did your voice make a different sound? Do you remember that?
Unknown Speaker 26:27
It means like
Unknown Speaker 26:31
evil.
Scott Benner 26:32
How did your eyes work when you're having your seizure?
Unknown Speaker 26:37
Free by doing so.
Scott Benner 26:44
It was real dark and it was scary. You feel like you turned into a monster? Yeah, you didn't turn into a monster sweetie. You couldn't see. And you couldn't talk? Yeah. You didn't know you were doing it. No, we don't think you knew you were doing it. It happened because your blood sugar got low.
Unknown Speaker 27:08
My eyes got
Scott Benner 27:11
trick I created I changed colors again. Yeah. Oh, what? Oh, you just saw that the camera was pointing at you. Yeah. Yeah. You don't want your picture Dagon? No, I just thought people would think it was interesting to hear what it sounded like when you're having your seizure.
