#284 Defining Diabetes: Brittle Diabetes

Defining Diabetes: Brittle Diabetes

Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.

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Glycemic Index from Harvard.edu

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

Scott Benner 0:00
This episode of defining diabetes is brought to you by in pen by companion medical. In pet is America's only FDA cleared smart insulin pen and app system that eliminates guesswork with its integrated dosing calculator. And that's about the least of what it does. Check out in Penn today at companion medical.com. There are links in your show notes at Juicebox podcast.com. In today's episode of defining diabetes, Jenny Smith and I will define a term that impacts your life with Type One Diabetes. Now you know, Jenny Smith from integrated diabetes calm, she's in all the pro tip episodes and ask Scott and Jenny, you know, Jenny, stop it. Don't act like you don't. If you want to hire Jenny, you can check her out at integrated diabetes calm, Jenny would love to have a private conversation with you. Let's see if she can help you with some of your diabetes questions. But for today, Jenny is going to help me define brittle diabetes.

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 healthcare plan for becoming bold with insulin.

At the end of this episode, I'm going to include a little I want to call it an outtake with me and Jenny, it might not be an outtake, it's a preamble, some chatter we were having before we started, you know, doing the defining diabetes thing. It's fine. And he's a hoot.

I would like to define brittle diabetes. And I am super interested in what you're going to say when I ask you, if it's actually a thing, or if it's an old timey term for I don't know what's wrong with you. It does have a definition, right?

Jennifer Smith, CDE 2:07
There is a definition and as far as like the old timey thing, I would say that that's more that's more appropriate, brittle diabetes. Used to be termed to or used to be something doctors called someone with diabetes that they just sort of threw their hands up and their blood sugar's were all over the place. And there was no, you know, do this and it works and whatnot. I mean, on a day to day basis, we know the variables that can go into management. So I think in today's world with technology and CGM, and being able to follow things, a good number of people who probably would have been called brittle, ages ago, or maybe even in the past five or 10 years with a really old doctor who isn't clearly up on what could be being done. I think they may have been called brittle. But in today's age, with what we can follow and track, many times, we get people who come to us even and they say, no one's been able to help me kind of get this contained. And we look at things and we start with like the basics that we've done before. And in the pro tips, kind of starting with beads, and looking at boluses. And looking at food impact and things that some people may have never really looked at before as the impact and how to pay attention to them. So we can kind of then you're not brittle, you just haven't had good information given to you about how to manage more consistently right. Now, I would say I hate the term, I hate the term riddle. But I would say that there are some people with long term diabetes, like you know, ages and ages, you know, 50 plus years, maybe, who may be at a point that there is there are potentially other complications in the picture. And that can make management of diabetes itself a little bit more cumbersome. And so you might appear a little bit more I guess, brittle. Again, I hate to use that term, because it's, it's, it's old. But when you've got other things like heart disease, or kidney disease, or even things with like neuropathy that might limit or change how often you could be active, or energy levels, all those things can impact blood sugar control. So it's not so much that it's, oh my gosh, I'm just going to throw my hands up and there's nothing to do about my blood sugar because I just can't management manage, nothing ever work. Sometimes its management of a couple of things to get the management of diabetes, more stable.

So

Scott Benner 5:00
with you on the idea of I hate, I hate it even bringing it up, because the first thing I think about is someone who's been living for such a long time with a doctor telling them, there's nothing you can do about this. You're just a brittle diabetic. And they're really buying into that and living a life around it and then turning this on and hearing someone go, that's not a real thing. Like, I don't want them to have that experience. Right. Right. But I also know that we define it, it's almost like taking a diagnosis away, it's like telling them Nope, you're definitely you know, you're crazy to think that your ups and downs, are, you know, something that you're doing wrong, because it's not, you've just not been given enough information to manage exactly, but at the same time, we we've already defined a couple of terms that, you know, bristle people, and I've get a lot of good feedback about I'm glad you tackled this idea. So I want to do this. So, you know, googling it comes up Rare Disease info.nih.gov. So this is the government saying that brittle diabetes is a term that is sometimes used to describe hard to control diabetes, it is characterized by wide variations or swings in blood sugar, in which blood glucose levels can quickly move from too high to low. And that's a fairly new, that's from 2017. That's not an old. Right? So I've always seen it as a, it's a, it's a give up from a doctor, it's just like, I don't know what's wrong, you're brittle. You know, like, like, you know what it reminds me of I and I hate to say this, but 50 years ago, if a woman 50 years ago, probably longer than that. Now, if a woman was emotional, they'd say what like, Oh, she has the vapors. She's prone to, you know, they mean, like, what that really meant was, some lady was saying something some guy didn't want to deal with. And they were like, Oh, you know how she gets, you know, like, you know, it must be hurt. Right? Like all that stuff that kind of like dismissive stuff, which I think really means my wife's trying to talk to me about her feelings. And I don't want to so let's just say she's crazy and get out of this conversation. And I don't think this is much different in that. It sounds to me, like, Doctor see these crazy numbers, right? Imagine it. Imagine no technology, you go in with your meter, and your meter says 35. And then it says 400. And the doctor doesn't know what to say. And the insulin is not as good as it is now. And you can't glucose monitor with a CGM,

Jennifer Smith, CDE 7:18
and the person hasn't had any notes. Because it's three weeks ago, when that happened. They're like, I don't know what happened three weeks ago,

Scott Benner 7:24
they're working off whatever bad advice they got 30 years ago from an endo. I mean, imagine what they tell people today, imagine what they were saying to people 30 years ago, it must have been just like, Hey, you stick that in there. And if you get dizzy, have a candy. You don't anybody was probably similar to that. Right. And so I, I shudder to think that there are people living today who think they're brittle, when I really believe it's possible that they just aren't aware of how to use their their insulin

Jennifer Smith, CDE 7:51
well, and even that definition that came from NIH in 2017, is there's no definition to why the variability could be there. The ups and the downs, we all have variability at times. And if you're, as we've kind of gone through, and many of the things that we've talked about, if you're not, if you don't pay attention, and make some notes about things or keep track of some things, or look at your data, you could feel very brittle, you could feel like nobody's ever going to be able to help me my blood sugar just does what it wants to do. And there's no rhyme or reason to it. And you know, whatever, I've just got bad diabetes.

Scott Benner 8:29
I think we got the bad griddle, Jenny, right, it just means like, easy to fall apart. Like the idea of something better, like a brittle bone, or a brittle twig or something like that. If you don't hold it with kid gloves, and don't move, it's just going to explode and fall into dust. Right? And it's just, if you're living right now and thinking you're brittle, please go back and listen to the prototype episodes. Because it's very possible. I mean, in less than, I hope this isn't the case. But unless you've gotten to the point, with your health, like Jenny described earlier, where there's where there's a lot going on, that's not positive. I mean, still, then you're not brittle, you just have complications, you know, like, it's so anyway,

Jennifer Smith, CDE 9:10
and there is different management then for complications and the diabetes component there. You know, I used to work when I worked as an inpatient diabetes educator and dietitian, there is very different management for people who have chronic kidney disease or who are on dialysis or those complications. They bring something in I also used to work on a cancer ward. And there are people who have diabetes and also have cancer that brings into the picture a whole host of fluctuations that happen. That doesn't mean you call the person brittle, but it means that there's something there to manage to help them also manage the diabetes.

Scott Benner 9:48
Yes, excellent. You know, your wife is upset in 1925. She doesn't have the vapors

Jennifer Smith, CDE 9:55
that she probably needed a hug or just to sit down and actually talk to somebody right

Scott Benner 9:59
should be affected. I opened his mouth and didn't cheat on her, she wouldn't be so upset. So anyway, I know you made me just now think of Nicole who was just on and I don't know if you've ever heard her Nicole's episodes, but Nicole came on prior to getting a kidney to kidneys, and a pancreas transplant. And then she just came on recently to talk about how it's going after the transplant. And one of the things she brought up is because her management was not great by her own admission for a very long time. She has gastro precice to Yeah, he actually has to consider her medications. right because of the gas or priestess like what if the, it doesn't get picked up in the right time? And that's just one of the things you just said. Like there's adjustments that need to be made based on your situation. Right, right. So, so Nicole's stomach isn't brittle. Nicole has no bruises, and she needs to do something a certain way. Correct. I like that. We did this one. Okay. Awesome.

Jennifer Smith, CDE 10:51
Yeah, it was good, too. It was definitely good to bring up because I think it's still it's still talked about too much. It is.

Scott Benner 10:59
Yeah. When I first said it to you, I had the same feeling in my stomach as I had when I said hey, Jenny, let's define non compliant. And you looked at me like really? Scott, should we do that? And I was like, No, no, we should. It's gonna be okay. And you're like, yeah, this is good. We're going down with the ship here, aren't we buddy? Okay,

Jennifer Smith, CDE 11:15
so that was a good one to noncompliant because I hate that word.

Scott Benner 11:20
Huge thanks to Jenny for coming on the show. As always, don't forget that you can hire Jenny right at integrated diabetes comm there are links right there in your show notes. If you want to check out Jenny may think there are links at Juicebox podcast.com. And of course, you can just go to integrated diabetes and give her a shout. Thanks also to in pen for sponsoring this episode of the Juicebox Podcast Do not forget, all you have to do is go to companion medical.com. And there you can find out where you stand with your diabetes care plan because the in pen app displays your active insulin, blood glucose and the last insulin dose. It also reminds you when to take a dose calculated recommend your next dose and warns you if your insulin is expired or has been stored outside of the recommended temperature range. Having an M pen is like having an insulin pump. But it's in a pen. Get it in pen. You get it you can get more Jenny and the diabetes pro tip series other defining diabetes episodes and of course, the Ask Scott and Jenny episodes. If you just can't get enough, Jenny, that's where you can find her here on the Juicebox Podcast. And now you're used to hearing Jenny say smart stuff about diabetes. Get ready to listen to her talk about other stuff where she sounds more human. We've been trying to figure out for Arden all year which is incredible. For network

Jennifer Smith, CDE 12:59
I don't know where you went

Scott Benner 13:01
where network connection and you were gone.

Jennifer Smith, CDE 13:03
are gone. All of a sudden

Scott Benner 13:05
you're like a little Blippi today. Kick your heels Yeah,

Jennifer Smith, CDE 13:08
I don't it's it's pretty windy outside here today and kind of overcast so that might be I don't know whatever happens in the atmosphere of cloud

Scott Benner 13:18
do you get your internet through satellite or you get it through like your cable system?

Jennifer Smith, CDE 13:23
I don't know I've got a little box in the corner of my office and whatever

Scott Benner 13:30
admit what I just said you is gonna end up at the end of one episode where people will feel better knowing that there are some things you don't understand at all.

Jennifer Smith, CDE 13:39
Have any no idea why

Scott Benner 13:42
he knows everything? Like how do you get your internet NO NO IDEA starts looking around the room like so. Anyway that was great. I

Jennifer Smith, CDE 13:52
come in and got a little I've got a little cable thing box in that I think I'm assuming it's the Wi Fi converter whatever it does thing Yeah, I I have no idea. Are you not surprised now that I could like like build a loop and actually make it work and understand it's working.

Scott Benner 14:10
I'm a little concerned that people are running around the country in the world doing things with their insulin just that you made up in your head?

Jennifer Smith, CDE 14:16
No, no, I promise not that. If you ask you this set up all of the internet connections and everything no probably not going to get done. I'll figure it out. Like I can read directions. I'm a direction follower. I got that from my dad. Everything that he brought home you took out the directions and you started with a like all like shelving units and stuff. All he got all of the Tupperware containers out and he put them all like by size and color and everything he organized them and we need one of a and we put it in the a hole and one at well. That sounds kind of weird, doesn't it? The

Scott Benner 14:54
no this is staying Yeah. Jenny just in case you're wondering. This is gonna be like the beautiful like last five minutes on episode people. Like just leaving the stupid stuff you say this is gonna be one of those that stays in.

Jennifer Smith, CDE 15:06
Anyway that I learned my organization of how to put things together from my father, he was very, very organized

Scott Benner 15:12
for clarity. Jenny learned how to put things in the a hole from her dad. So I like him to hear this.

Jennifer Smith, CDE 15:22
He's not unfortunately, who passed away? No, it's okay. He passed away about 10 years ago, he had, he had kidney cancer. So

Scott Benner 15:31
I'm horrified to tell you that I wasn't sorry to hear that he was passed. I was sorry to hear that he couldn't hear what you just said.

Jennifer Smith, CDE 15:37
nature of what I said yes. And he would have, he would have liked it because he had the greatest dad jokes. Like in the world, my dad had a great sense of humor, so he would have loved it.

Scott Benner 15:50
To do something here on the Mac, right? Okay, so I just want to prove to you all that Jenny's a real human being she's not perfect. But she has a great sense of humor. And she does not know how her internet works. At the end here. You know, just let me tell you that podcast just hit 500 reviews on iTunes, which was really touching little plateau, for me. Quite a little milestone. Most of them are really good, which is also very nice. I want to thank you too, because the podcast just hit 1.2 5 million total downloads for the whole show, which is a really incredible thing. And I've probably said before, but it the first month of the podcast back in February 2015. I think there was something like 1000 downloads that month. And now I can't, you know, get 1000 downloads like every couple hours. As a matter of fact, by the time you hear this episode, November of 2019, will become the most downloaded month in the history of the podcast. And that happens a lot. Where the next month like we're one month does better than the last month over and over again. That really is to do with the podcast being shared by listeners. I have no budget for marketing. And I can only hope that when the podcast grows, that means that you found that helpful, or entertaining or thought provoking or something and told somebody else about it. Which I really I didn't expect that either. I know when hindsight it seems obvious, right? Somebody will like it, and they'll tell somebody else. But in the beginning I I really didn't think that would be I don't know, I just didn't imagine. And you know, reflecting here just a couple of hours past Thanksgiving. I'm really thankful for it. Actually, I was looking through my photographs. So I'll leave you go back to your life after this. I was looking through some photographs from two weeks ago. And I was in Kansas City at the jdrf type one nation event. I did four talks that day. Right. It's a think the thing started at 9am. And it was over my for for for those hours, I was speaking in a room. Not concurrently, although almost. And the first hour was just sort of thinking about your diabetes differently kind of talk, I sort of introduced people to the idea of the podcast. But then in the second hour, I talked about, you know, kind of the tools that we talked about here and give people sort of like a one hour if you can imagine, like the whole idea of the podcast on one hour. It's me talking pretty quickly on stage. After that, I did a q&a, where we talked through people's like real life issues. But at the end of the day, I sat down with the teenagers who were were at the event. You know, at first, um, they looked like teenagers coming into a room being told that, you know, this old man here is going to explain, you know, something to you about diabetes. And they sort of all came in like they know, somebody promised them something if they just came and said still. Maybe they had been a cost, you know, but in a couple of minutes. I got them talking and I got them laughing and started talking to them about their health and how they could possibly feel and you know, 10 more minutes later, a couple of more taking notes, and asking questions, and then the quiet ones in the back got engaged. And I don't know I was thinking about what I was thankful for today and you know the things in my life aside, my family and the people I love you guys for listening. I just started thinking about those kids. And I was really grateful that they listened. Anyway, I don't usually say what I'm grateful for Thanksgiving. But I think I'm grateful for you guys sharing the podcast to the point where it got me invited to an event in Kansas City, where I met a few kids whose lives might be different now. Because you told somebody else about the show, I'm going to put a picture of those kids up on my social media. So if you're listening to this, it's going to be right around. Thanksgiving on my social media. You can find the date scroll back.

If you're listening to this later, okay, this is me being all serious and quiet. Thanks so much for listening to the Juicebox Podcast. There'll be another episode on Tuesday, and every Tuesday and Friday from now until at the very least, the end of 2020. Because all of the sponsors are back plus some new ones. So huge thanks to them. Huge thanks to you guys. Hope you have a great rest of your 2019 keep listening to the show and sharing it and I'll keep making it. Hey, one last thing I need some new equipment to record with. So buy some t shirts maybe or a sweatshirt or something maybe at Juicebox podcast.com. Or you can make a donation to the podcast if you want just scroll down and you know every episode, there's a spot there to do that. Anyway, I'm not begging, I just need another microphone, a new preamp, my computer's starting to get to the end of its life. So there's gonna be some expenses coming up in the next couple of months. And if you would like to help with them by you know, picking up a sweatshirt or dropping five bucks on me or something like that. That'd be really cool. If you can't, please don't think twice about it seriously, I don't want you to feel bad not even for a second. Just keep enjoying the show, sharing the show. And I will I will take care of the rest. But But if you're just sitting there right now thinking I got a couple dollars I can handle that. I'm not going to stop you as they say, but I would be very appreciative

About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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#282 Ask Scott and Jenny: Chapter Seven

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

• Are growth spurts a gradual increase or all at once? Strategies for evening spikes.

• Any tips for being bold with insulin with the Medtronic 670G pump in auto mode?

• Let’s talk about tricks for Loop, being flexible and learning from your experience.

• Let’s talk and compare Control IQ, Basal IQ, Medtronic 670G and Loop.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - 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
This episode of Ask Scott and Jenny on the Juicebox Podcast is brought to you by companion medical makers of the in pen. To learn more about in pen, go to companion medical.com or click on the links in your show notes, or Juicebox podcast.com. Are you wondering why I want you to visit companion medical.com? Well, that's simple, because in pen is America's only FDA cleared smart insulin pen and app system. When you get to companion medical.com, you'll discover that in pen combines an innovative diabetes management app with a Bluetooth enabled pen injector. This will simplify the constant tracking monitoring and calculating required for insulin therapy within Penn MDI users are able to live life less complicated. Welcome to Ask Scott and Jenny. These are the episodes where Jenny Smith from integrated diabetes services. Now Jenny, you may know has had diabetes for decades. She's a pump trainer. She's a CDE. She's I think once she went to the moon, I don't remember exactly, but she's done a lot of different things, right? She's also a nutritionist. Listen, she's everything you want. Why are you arguing with me? No, you're not arguing me. And anyway, Jenny and I. We answer questions from you guys. They're left on the boat with Vince on Facebook page. I asked for them every once in a while. I do it real slick. I go like this. Yo, does anybody have any questions for me and Jenny? And then people leave questions and then we answer them. Anyway, today we're going to talk about growth spurts, the 670 g from Medtronic loop tips and a little bit about control IQ. What do you think of that? Hmm? Okay, then. 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.

Laura says kids and growth spurts Is it a gradual increase or an all at once change? Is that something that you notice they need more of all the sudden that she gives her example toddlers for him was five, still close to some still close to the same ratios? ISF and bazel. From when he came out of honeymooning. I know he's gonna hit a growth spurt soon. And I guess she's looking for like, How do I know when it happens? And what do I do? And I think this falls under the auspice of those of the idea that I just want somebody to tell me how much or when, like, you know, do you mean like, give me a number or an idea? And I don't know that there's a specific answer. I have a general answer. But I wonder what you think about and what you see.

Jennifer Smith, CDE 2:59
Yeah, and my answer is probably similar to your general answer, honestly, there's not a, there's not going to be a specific like, you're always going to see 25% more insulin needed, right. I mean, it could be over several growth spurts that you notice, gosh, he always need like an extra point one added or an extra 25% or whatnot. But it's, it's not that cut and dry by any means. one specific time though, that most parents with kids with diabetes, and parents of teens with diabetes will notice the heaviest impact of growth. With a surge for only, you know, a short amount of time is evening, where their kids go to bed, they've had things really nicely contained. And all of a sudden they get these like spikes. Almost as soon as the kid is snoring, like their head hits the pillow, they're snoring, and up it goes they've been at this beautiful 111. And up it goes and they fight it and fight it and fight it. And it could be an all night fight depending on how strong the growth surge is. And in those instances, it's okay, let's try it. I usually encourage people to try first a temporary bazel increase rather than shooting it with like a dose of three units of insulin and then chasing the drop down. Attempt bazel increase, you know, that might be significant. Maybe it's 50%. Maybe it's 100% more for a time period. See where it levels off? When does it start coming down? You can always shut off attempt it is all right. So and then if you learn from that, let's say two nights in a row, you start to see this surge on the second night when it gets going. You hit that Temp Basal again, similar to the night before if it controlled Well, if it wasn't quite enough, and you still fought a high pump it up even more. But then once that growth spurt is sort of reversed They may need not as much like as the Temp Basal you are giving to offset the rise. But their overnight needs may definitely go up, you know, they were at point to their growth spurt needed a 50% increase overnight for that time period. And now instead of being at point two an hour, now they're at point three or point three, five. And that might be where they sit for a time period until another growth spurt happens is

Scott Benner 5:28
that going to be because there's more body mass, like you've actually grown? There's more of you, or

Jennifer Smith, CDE 5:34
potentially or just the changes that right? I mean, in little kids, especially little kids, I sometimes, you know, with mine, especially my almost three year old, sometimes he wakes up in the morning, and I'm like, you grew right? You just like, all of a sudden, he just let you look bigger, you look like your cheeks are slimmer, or you know, he just looks bigger. And, you know, so sure it can I mean, it wasn't technically overnight that he just shot off. But those, you can suddenly kind of see it and people who are attuned to their kids, especially parents, with little kids who you're following so many more things than just which truck they want to play with, you know, staring at them constantly. And, you know, I mean, with diabetes, you pay attention to so many things. So you could like I said, you could see a tremendous need in a spur period, and then it levels off, but it doesn't come back down to where they were before the growth spurt. Right?

Scott Benner 6:32
I have to say, I think the idea of looking for physical clues is brilliant, because I know our son, his calves would get thicker. Like all of a sudden, you'd look at him and his calves would be out of proportion with the rest of his body larger. And then sure enough, he would get taller. It was almost like his body was like, okay, we're getting ready to do this. You know, like, and it would store things in certain places or something would get bigger sooner. It was just really it never failed as he was growing and I have to say to door jamb that you don't mind drawing on with a pencil is great as you have children, a few people have younger kids. I'm sure you're doing this, but it gets really fun. A decade later, when you're like stand there for a second, you know, and and you get to see how they move up. I would say the answer to this question to me, is the core of the of the podcast, right? Oh, hold on a second. Arden needs a little help with their balls for a second.

Unknown Speaker 7:26
That's okay.

Unknown Speaker 7:29
What is six times

Jennifer Smith, CDE 7:30
we don't use the door jamb we use a my mother in law when our first was born bought us this like measurement tree, and you put it on the wall and kind of pop it in. And same thing, same idea, you just push the hash marks on to the tree as the child grows. But the nice thing is that we've used one side of the tree for Oscar and the other side of the tree for Conan. So we can see where they both are. And it's kind of fun to now be able to see where was Oscar? And is Conan meted out the same? Or is he getting bigger faster? Or are they growing about the same? It's kind of fun? It really

Scott Benner 8:08
is. I have to say my wife has told me without a doubt if we ever sell this house, she's like, you have to pry that board off the wall and replace it for the new owner because I'm taking it with me. And I was like, Okay, yeah. So anyway, what I was going to say is that I think this is one of those questions that if you just caught me, if you texted me real quickly and asked me this question, I would say to you, this is why the podcast is terrific. Because you are running into an insulin need. And it's saying to you, I need more insulin, give it more insulin. Try not to worry about why just it does. And when's it gonna start? When's it gonna stop? I don't know. It does kind of suck. I'll tell you like, you know, because after four or five nights of this, and it goes away on that six night when you're finally like, I trust this is going to happen, jacking up bagels and bolusing and everything. And then it turns out, the growth spurts over now you're waking up somebody at one of the morning going, hi, would you like a chicken sandwich in the banana? It's a it sucks. But it works well for those six days. And in my opinion, it's better than being high for six days and just saying, oh, it'll come back again. Right. You know, I just think that's how I would handle it.

Jennifer Smith, CDE 9:15
Correct. And anything, you know, you bring in a good point, in just the comment of when it comes back again, because it will little kids grow and grow and grow and grow and even teens, you know, up to a certain point, girls grow for less time than teen boys do. I mean, teen boys can grow up and into even like 18 to 20 years, some boys. I mean, most often majority is done by like 18 years. But most girls are pretty done growing up by about 16 years old. You know, they look

Scott Benner 9:53
so much older than the boys even when they're 1314 like in that range toe,

Jennifer Smith, CDE 9:57
right. So you know know that In the nature of all the testing and the things that we've talked about in the other podcasts and the figure out the bazel, and figure out the ratios and all that kind of stuff, it's it's not a number that's gonna sit there until they're well into their adulthood, when maybe a variable component of their lifestyle changes, where they will need to make an adjustment. Kids needs change. That's the simplest way to say kids needs change. So don't think you're crazy. If you go for a couple of weeks, you're like, I got this. It looks like it's working magically. And then, like, professionally, I get these emails. They're like, I thought we had this all figured out. It was all working beautifully. And now the last three nights, this is happening again. I'm like, Okay, well, we need to adjust. Right.

Scott Benner 10:47
So Jenny answers those emails by how do you think we stay in business? It's gonna keep it's gonna keep changing. But But no, I genuinely think that's a great answer for that. Okay. Richard says, any tips for being bold with insulin while using Medtronic 670 gene auto mode, you basically can't adjust the bazel other than temporarily turning on the target of 150 bg instead of 120. And it auto calculates bolus based on carbs, BG or a combination of both. It won't do a correction bolus, unless you tell it your BG is above 150. It adds up to great time and range stats for me range being 70 to 180. But I'm spending a lot of time at the upper end of that range. And I'd like to be closer to the 120. I know Arden and Jenny are Potter's but I think Jenny's colleague, Gary uses 670 g maybe? Well, Richard, I don't know how comfortable I am with everyone knowing so much about our lives. But But I am going to have, I finally have some insight into this automated pumping thing. My brain is starting to almost get all around it. But Jenny is going to go first because I've never seen the 670 g before.

Jennifer Smith, CDE 12:03
Yeah, so the 670 G. M. I said it's hard to sit too long, if it is a long pause, because I have to, I have to be kind of, you know, good in the way that I explain it. Because the 670 g can be phenomenal for some people knock the majority of people. But for some people, it does work quite well. Who does it work quite well for? If you have a pretty structured life, if you have a pretty typical breakfast, lunch dinner, you always go to the gym between four and 5pm. You know, it can be a really good system for holding you a lot more stable, it does do a really nice job, for the most part, again, in those in that type of a life for the overnights, similar to the other, you know systems that do something like this with the augmentation to the bazel and how it goes up and down. But I can see that the 670 for a good majority of people with the variability of today's lifestyle. It doesn't meet need. And for run really specific group. Women in pregnancy it doesn't meet need because it doesn't target the right blood sugar, at least not right now. Nothing Medtronic isn't working on that, from what I understand future iterations will have lower targets and different things to it. But the current 670 You know, it targets the 120. I would say for most people who are having success with it. They're typically getting an average blood sugar of about like 130 ish, not really 120 even though technically it's targeting that. And this question kind of alludes to that piece is that it's really not allowing any corrections unless you're above a higher number than you really want to be at anyway. Right. Right. And it's only correcting you down

Unknown Speaker 14:07
to 150.

Scott Benner 14:08
Yeah. Okay. So it's

Jennifer Smith, CDE 14:10
never really getting you too that that technical target. The other component to the system is that it's, it's not using your current manually set bazel profile to work off of with its increasing and decreasing of insulin dosing through the course of the day based on glucose change. It's I we kind of call it the secret sauce of whatever Medtronic has figured out in their algorithm. The system a couple of days of manual mode use gets an idea of your average of insulin need and kind of like a sensitivity and your sensitivity to insulin and what it does, then use it Essentially doses your insulin along the course of time in a day, based on what it is seeing your sensitivity look like. So really the only factor that in auto mode 670 is using is your insulin to carb ratio. If you've got it set at a one to 10, you're going to get dosed off of a one to 10 along with where your blood sugar is, and that kind of stuff. But even your ISF or your sensitivity correction factor, that is not what auto mode is using. So, you know, it's kind of a long,

Scott Benner 15:40
but it's a limit. It's, I mean, I guess you'd call it a limitation of the system. But not a limitation. I guess it's how it was designed to work. It's not working the way and I see the problem. If you're at that top end of that range, or 175, and you're heading up. And without intervention, you're going to get to 240. But it only intervenes enough to try to get you from 175 back to 150, then that's where it won't work, right. Don't forget what companion medical wants you to know, they want you to know about the in pen. The pen is not just this beautiful Bluetooth enabled insulin pen. It's also an app that works in Congress in Symphony in think of another word that means like all together between your app, the pen, and your dexcom continuous glucose monitor. The app is going to give you an at a glance, look at your current status, from last dose to active insulin to recent doses. It has a dosing calculator to help take the guesswork out of dosing. That's a huge help for MDI, right. You'll be able to enter your blood glucose and what you intend to eat. And the correct dose will be recommended to you by the Impact app. I come on. If you're MDI, you got to admit this seems it seems like a leap, right? Here's dosing, reminders and reports and temperature alerts, there's a whole bunch of stuff but you'll learn all about it when you get there. When you get to companion medical comm so for those of you looking to take a pump break, for those of you who are already doing injections, and just wish you had a little more judge get out I mean, in pencil way to go. I want to thank them, of course for sponsoring this episode of the Juicebox Podcast. And I will thank them by reminding you to go to companion medical comm to find out more. Oh, there's extra time in pen is terrific. Why are you not trying the in pen, go get in pen today. companion medicals.com or on the links to wait hold on a second get even deeper. Check it out today at companion medical.com.

Jennifer Smith, CDE 17:55
Many people who will complain in auto mode about getting what we call kicked out of auto mode and kicked back to manual. What two scenarios one in the example you give as blood sugar is rising, and the system is micro bolusing. Along the way, they don't call it temp increase, they just call it this micro like bolusing along the way that the system will only micro dose for a set amount of time. Yeah. Before it says Nope, can't help you anymore. And out of auto mode, you get kicked back into manual mode. Okay. So on the opposite end of that if you're like low, and it can only adjust so much in a low time period. So you could get kicked out of auto mode as well.

Scott Benner 18:47
On purpose,

Jennifer Smith, CDE 18:49
you can you can choose to turn auto mode off going back to manual mode, which is I've got a couple of people that I work with who've been using 670 for a number of years already. And they've figured out the tweaks and the tricks and the things which we actually have on our website. I've got a lot of little tips for you if you are using the 670 These are some of the little nuances and this is how to like do it better essentially. But some of the people I work with just when they see a higher blood sugar and they know that this system isn't gonna adjust it as well. They just go back to manual mode, they add a corrective and they take care of it and then they go back to auto mode once the cyst once you're brought back to where you kind of want to be. Yeah,

Scott Benner 19:36
I see with what I see with lupus. I now have figured out two things when it looks like it isn't going to stop arise and how to get out of opening the loop. So as soon as I see that up, then I go Hmm, that's not working. For some reason. I bolus what I think is a significant amount I bolus an hour's worth of her bazel Plus, whatever I think the rise needs to correct. So it'll be sometimes sometimes I'll be like, open the loop and bolus four units, which is, which is a lot of insulin to try to stop. Because what you're really looking at is a 135, diagonal up, which doesn't make any sense to put in for it. But it does if you understand what the algorithm is going to do next. So you're going to open the loop, it's going to go back down to your base, you know, base, I'm going to try to stop the rise anymore, it's just going to go too far. Now, I think it's like 2.4, something like that an hour. So it'll go to that. So I've put in enough insulin to stop the stop the arrow, stop the momentum, bring it back. And then when I get momentum coming back down, I figured out and I can't obviously pass this on to any of you. But I can look at the Dexcom graph and go close know when the court follows it now, right? And so you close it now. And it's almost like, it's almost like flying or landing an airplane without your, without your gauges, I guess like you just look at the ground and you go, I gotta start pulling up right now this is it. And, and it works. I can't believe I can't believe I figured something out about looping, to be perfectly honest, you know, a workaround for it. And it's a workaround, that doesn't cause a problem later. The only way you can get messed up coming out of open loop is if you're if you close the loop, and then go right into a meal again. Because then right, then you'll put in, and this just happened while we were doing this, you'll put in art and just put an ad carbs for a large lunch and had a bagel involved in it. And she said, it didn't give me any insulin because we just came out of open loop. And I was like, That's alright, because I wanted this to be 11 units. So still put in the car absorption is 40 over two hours, 40 over three hours, which by the way, spreading out your carb absorptions stop multiple different stops, it stops it from shutting off bazel because it thinks oh I have to stay on for a long time you trick it. You're smarter than the loop, damn it. And then so you get up 40 and 40. And then I just told her Bolus all 11 units. So now it has the 11 units to work with. It has the absorption times in and then it will make decisions about bazel based off of those other two things. And more importantly, I win Jenny.

Unknown Speaker 22:25
Important. Right? Oh, wait, yeah, Arden wins because she's healthy.

Scott Benner 22:32
I defeated that damn thing. I feel like I beat a robot in a sci fi movie. You know, like, like, it came at me with like a spitting action a torch. And I was like, I'm gonna die. And then it was over. I won.

Jennifer Smith, CDE 22:42
I was just like, I can't move on. Yeah, but that was I know. And why why are you winning? You're winning, because you've watched and you've learned?

Scott Benner 22:49
Absolutely, it took me a while. I am telling you this in October. And when did Arden go on loop? It's got to be like six months ago a while right? And, and people at that time were like, oh my god the boat with insolent guys looping. We'll all have great directions for looping in just three days. And then you all emailed me for months. Like tell me what to do with looping. I was like, I am still. And so when I tell people, it, they're never mistakes. It's always a learning situation. I that's exactly what I did. I hate to say it because I think it sounds a little douchey. But when I don't know what to do with diabetes, I go back to what we talked about in the podcast, I just, I revert back to the basics. And I go, okay, what's happening to me here, and then I apply one of those protip episodes until I know, it's, it's a little strange, because I'm the one that said it the first time but it's a great example of how in the middle of life, you can forget things you know, you know, like just because it comes at you from a slightly different angle all of a sudden, and it doesn't look the same as you expect it to you panic and you go different thing don't know what to do, and it's over. But I just kept applying the tenants of the podcast until I figured out the loop thing. So I am so close to us doing that.

Jennifer Smith, CDE 24:01
You know the same thing. I mean, I learned I've learned a lot over now two years Actually, today is my two year anniversary of using loop.

Unknown Speaker 24:10
This is your loop version started

Unknown Speaker 24:11
on Halloween.

Unknown Speaker 24:14
Yeah, by the way,

Jennifer Smith, CDE 24:17
it was what actually you know, to be quite honest, as most people do, you know, I actually I started in closed loop the evening of October 30. And by like the morning of the 31st I was like

Unknown Speaker 24:31
coupon open loop like

Jennifer Smith, CDE 24:35
so I closed it and it was it was actually really great. I mean, I got a chance to trick or treating with my boys and whatnot. That evening. It was was really cool to be able to watch the system and I would have usually applied like some type of temporary bazel or just plan to like steal candy out of there like buckets as We are treated along the way. And it was really fun that Halloween because I didn't feel the need to pay attention, nor did I get any alerts while we were trick or treating, because Luke was doing a great job. And so I don't I think it was kind of a fun day to have started it. So

Scott Benner 25:23
don't test yourself a little bit, right? Don't Don't

Jennifer Smith, CDE 25:25
Yeah. But again, learning, you know, I learned, you know, like my coffee in the morning, I typically found pre loop I had they have a half a unit of insulin to cover. Well, that wasn't based on carbs. It was just what I had learned to utilize. Right? Well, now in loop, I had to actually go back and figure out how much does that equate to as far as like a carb entry for loop to really cover this? Yep, the right way to offset that like caffeine rise and everything. So there is there's relearning to using these hybrid closed systems, whether it's the six, seven dg or loop or open APS or whatever, there are pieces of things to learn that you weren't applying before. Or maybe you were you just have to learn them in a new way with the system. I

Scott Benner 26:18
think that's that's it. Arden right now is at lunch. She's 75 her blood sugar 75. Here's how the morning when she got up in the morning with a pod that only had a couple of units left in it. So we swapped it running out the door, swap it as she's getting that little bit of a rise from the morning, right. So I see like a 120 is starting to creep up. She was one on one while she was getting dressed all sudden, she's 120. I threw in a unit from the old pod because I didn't want to waste it took off the old pod put on the new pod, looked at what insulin was pending for lube, bolus pending insulin. Then she started we drive into school and I just noticed that I felt the number jumped too much. And I was like open the loop and Bolus two units. So now I'm thinking about pod change insulin right. So we Pre-Bolus two units I comes in perfectly forget to close the loop this morning, I'm running around doing a bunch of stuff we forget to close the loop. So then something hits her where she needs more bazel loops, not closed doesn't work, she starts going back up again. 134 diagonal up at 9am. Now I'm like Oh, she's got to eat an hour and a half. reopen the loop Bolus more 91 diagonal down when she wants to eat. And then you heard the rest. We closed the loop tried to do 80 carbs, it didn't want to it didn't want to give it to her. So I gave him the sweet we set up the the absorption times and gave the insulin anyway. And now she's eating and she 75. And I'm telling you two months ago I don't even know where her blood sugar would be with loop right now it would have been a disaster. But I needed that disaster to happen. So I could wrap my brain around the whole thing really. So I'm very, I'm doing very well with it now. Like I can't wait to see what hurry once he ends up with being three full months of this kind of new space. Alright.

Jennifer Smith, CDE 28:06
And it kind of goes along with I think one of the last times we did a we did a chat like this there was we kind of both talked about like taking a hit. Right. And so I actually for our newsletter for October newsletter, I actually did an article about what you can gain like taking a step back in order to take two steps forward. You can learn from the hits that you end up taking Well, my blood sugar did do great for, you know, this five mile run that I planned. Okay, well, what did you do? What didn't work and plan accordingly for next time you you can learn from taking some steps back

Scott Benner 28:47
hundred percent you have to stop every once in a while you just have to broaden your scope and stand back and see the whole picture. Because you're just telling the fight. You know, it's funny. The it's a completely strange, I thought but I think in my mind, it's the same thing. Phillies hired a new manager the other day, Joe Girardi he was really successful manager with the Yankees for a decade, you know, left there. And it's been out of baseball for a couple of years. And he said, I heard him in an interview. He goes sometimes when you're in it, it's hard to see it. You know, he's like you're in this fight. And you're so focused on winning, or I guess in this situation, you're so focused on your blood sugar being where you want to be, you don't see how it is you're losing or winning. You don't know why anything is working or not working. You're just swinging hands, you know. And so I think that's a perfect scenario. I think you got to step back and just look at the big picture sometimes. All of these things that have been on T shirts for the last 50 years have been there for a good reason. It had everything we just said about 670 G and looping. does it apply to basal IQ as well?

Jennifer Smith, CDE 29:55
I think it probably will apply more to control IQ. Okay. Which is basically like you really is only a predictive low glucose suspend, right? So the system is looking for glucose to be less than 80 within the next 30 minutes. And if the trend in glucose is happening such that that's going to be the case, then it predictively suspends the insulin delivery on a basal level. But the interesting thing about it is that it actually doesn't do only bazel suspension. It also suspends an extended bolus. So if you are using bazel, like you, and you have a trend happening, and basal IQ kicks in, and you've got an extended bolus, your extended bolus will be stopped. And so once these like you kick things back on, you have to remember to go back in and either resume an extension of what was missed, or just Bolus for the rest of what was missed, depending on how long bazel iq was kicked off. So that's a kind of a nuance to that system and control IQ will be, I would say, closest in similarity to 670 G. Neither of those systems are by any means close to looping in any sense, you know, loop open APS, Android APS, I, the the current approved, hike, sort of hybrid clothes are just not, I mean, from the basic information about the research of the control, like you, and the people who have used it in the trials, it seems to do a good job. Again, it's conservative, similar to the six, seven dg in what it does, but some of the factors that it uses to adjust. From what I understand it does use your set bazel in the background to adjust off of rather than its own secret sauce of applying a bazel does use your current sensitivity factor as well as your carb ratio. So that, in my opinion clinically, and like if I was going to use it personally, I think that those are big steps beyond 670. Because it's using some things that is, as we've talked about, if you know that your settings are good, why wouldn't you want a system to work off of what you already know, is working to a degree, right?

Scott Benner 32:27
It seems like these systems are, are set up. I'm sure there are people who have been living their lives in the two hundreds and the three hundreds who are on these systems and think this is amazing, right? It's just not the next level of what can be done. Okay, and I'm assuming they were set up on purpose like that. That's what they were made for. And they're probably doing a really good job for the people that are working for.

Jennifer Smith, CDE 32:46
Correct. Yeah.

Scott Benner 32:53
Huge thanks to em pen from companion medical for sponsoring today's show. And of course, the Jenny Smith from integrated diabetes. Did you know you can hire Jenny, you can go to integrated diabetes.com and then find Jenny. I don't know what you'll do it. You'll figure it out. And then you can email her also right there in the show notes. There's Jenny's email address. That's probably easier. You click on that you send an email. Here's the email says, excuse me. Hmm, I'm composing. Dear Jenny, I heard you on the Juicebox Podcast comma. I love you exclamation point. Can I please give you money to help me question mark, and then you sign your name and she'll get back to you

About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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#280 Billy Gardell Hearts Health

Billy Gardell from Mike & Molly, Bob Hearts Abishola & Young Sheldon…

Billy Gardell (Mike & Molly, Bob Hearts Abishola, Young Sheldon) shares how it felt to be diagnosed with type 2 diabetes.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Welcome to Episode 280 of the Juicebox Podcast. Today's show is sponsored by companion medical makers of the in pen. In pen is a smart insulin pen that talks to your Dexcom and its own app, giving you the functionality of an insulin pump. It'll keep track of things like insulin on board, the temperature of your insulin, all kinds of cool stuff, you really have to check it out. There are links in your show notes that Juicebox Podcast COMM But you can always go to companion medical comm to find out more. All right, we have a treat today. A special guest. I think I remember Billy gardell first from Bad Santa. I very much enjoyed Billy's work again on my name is are all a television show with Jason Lee from I think back in 2007 that I adored. After that I saw Billy again where we all did his hit television show Mike and Molly where he and Melissa McCarthy played a married couple. More recently, Billy has been on young Sheldon and today he is again starring in his own show, Bob hearts abishola, which will tell you a little bit about later. But first I'm going to talk to Billy about what it was like to be diagnosed with type two diabetes.

Billy Gardell 1:15
Everyone's always talking about the differences between type one and type two diabetes. But the one thing that's absolutely the same is how it feels to be diagnosed with a disease have to adjust your life and come to terms with what's going on. And that's what Billy is here to talk to us about today. 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.

Unknown Speaker 1:59
Okay, man, it's a billy I'm not

Unknown Speaker 2:00
gonna waste time introducing, I'll do that when you're not on the clock.

Unknown Speaker 2:03
Sure.

Billy Gardell 2:05
So I have four questions. And my first one, my first one is this. I had a health scare this year where I had some symptoms that mimic type two. And right when a doctor just put it in my head, I got home and I couldn't bring myself to eat. And and yeah, just because of the fear. And I was wondering how how that diagnosis initially impacted you? Well, it was it was really scary. You know, I've been lucky, you know, my whole life, I've really never had any trouble. And the way I found out mine was the way a lot of people would type to find out, you know, a lot of people are walking around undiagnosed. And I had gotten my checkup and my physical and we did a battery of blood tests. And my a one c came back. I think it was seven, two. And so that sent off all the alarms and whistles and I had the same exact effect man, I because I was like when I got home, I was scared to eat something. Because once they inform you, you know what type two can do to you if it's untreated. And if you let it go Can you know can really cause a lot of damage to your body. And it does scare you into thinking oh my god, I have to learn how to manage this thing. And in the meantime, you do have a panic about everything you put in your mouth at the same exact reaction. Yeah, mine was really inflamed because my daughter has type one diabetes. It's why I have this podcast. Oh, okay. I understand the impact of food on blood sugar. And I just stood in my kitchen, those my wife said she doesn't think I ate for a day and a half. Yeah, I think I think I about felt the same way. And then I got into this obsessive thing about taking a walk the minute I ate anything, you know, just trying to burn it. So my body would you know, except for the right way.

Unknown Speaker 3:51
See, I'm glad you're talking about it like this, because people have

Billy Gardell 3:54
note with type two don't usually speak really honestly about it. And I think this is what people need to hear. It's just a completely misunderstood thing. Yeah, and I think it's important to to say it and one of the reasons I joined the my type two Transformation Program was because I couldn't if I committed to that I wasn't able to deny it. Yeah, you know what I mean? The one of the reasons I got on board was not only one it's changed everything for me and really improved everything. But the other side of it was if you put a spotlight on it, you can't hide from it. And I figured, you know if I if I can do it, maybe other people will see that and they'll try to take care of it too. Because you know, I've been a big guy my whole life. I know how to play the denial game with food. You know? I can I can still waddle by a mirror and go Alex All right. A shadow that you know and and by putting the spotlight on it. I think that's what's helped me start to treat it. Yeah. Would you call that accountability? Or is it just the idea that you know, I find even this podcast which is now five years old and has like well over a million downloads and it's doing something. Thank you very much. But my point is, is that when I put it out the first time, I had this idea. And I thought, let me just say it out loud, so I can't back out of it. Yeah, that was my that was exactly how I felt. Man, I felt the same way when I decided to do this, because I just I needed to pull the curtain back, you know, so there was no place to hide from it. Because I don't think you can change or overcome anything until you first accept it. And I think that kind of helped me accept it. How long

Unknown Speaker 5:28
ago? Did this happen to you? How long ago? were you diagnosed?

Billy Gardell 5:31
I want to say it was about 15 months, about 15 months ago, I found out it's really new for you, then well, yeah, I mean, but I don't know how long they once he was, you know, out of control. Before that, it just, that's when I got the blood tests back and realized it was seven, two. So I don't know how long I've been walking around with it beforehand, you know, but I gotta say, since doing the my tape to transformation stuff, you know, the combination of exercise, diet and medication, that I feel a lot completely different. Like, I used to be way more lethargic. And, you know, sometimes my vision would be a little bit blurry. And you know, or sometimes you just find yourself, you know, falling half asleep midday. And so that stuff has gone away. And I'm very grateful for that. You know, I interviewed Anthony Anderson once and his he spoke about when he was growing up how his father had problems like that, and they just really didn't do anything about it like something like blurred vision that you would think would make stand you up and go, I gotta go to a doctor and find out what this is. Yeah, well, I think your first reaction is just I must be tired. That's not it, you know, there's something much more heavy going on. Absolutely. So I guess the next thing I want to understand is, once you're acclimated to the idea, I have type two diabetes, what were the first number of steps you took to try to improve things for yourself? Well, the first step I took was, you know, making a plan with my doctor, and, and deciding which medication was going to be right for me, and how did you start changing diet and exercise. And then I was through my agent and a friend, they told me about this program that might try to transformation and we were contacted by them and and once I understood what they were trying to do, and research the program a little bit found out it was right for me, man, I just I dived in. And then you know, I'm a big believer that I'm one of those guys that if I can do it, anybody can do it. Yeah. You know what I mean? If I can, if I can try to pull this together, then I think anybody can and, you know, if you can inspire someone to change something for the better in their life, you know, that's a good thing. I believe you will I I've seen just what the podcast does for people living with type one. And I think that that one of the first things people need is a sense of community, and an idea that somebody else understands what's happening. Like it's not just happening to you. Right and and, and, and I think opening your mouth and talking about it, it cuts the fear down, because then you're able to address it.

Scott Benner 8:08
Well, I'm a huge proponent of what you're doing. Because as somebody who's been no of course is I've been in the diabetes me for so long. What I've seen is, like I said, community helps people with type one, there's a huge community around type one, but it's hard to get a type two community going. And sometimes I think that's just because people don't want to put the label on themselves that they have type two diabetes, did you think about that before us started?

Billy Gardell 8:31
You know, man, I I'm at a place in my life where I just want to be around as long as I can be here for my son, and as long as I can annoy my wife. So that was that was motivating enough for me to go, you know, I gotta, I gotta accept that this is real. I think you know, the things you don't accept is the things that kill you. And I imagine you don't have to worry about work because you're like a Chuck Lorre player now at this point. So it's like old time along the way, man. I tell you, man, I the fact that I'm in another Chuck Lorre show is, I mean, one time is hitting the lottery. I don't know what you would call this. I'm starting to feel like that Irish guy goes out in the woods and gets hit by lightning every time. I said to my wife, I was like, you know, Billy's gonna come on the podcast. And she's like, Oh, he's on mom. I'm like, No, I think you're thinking of another show. And she goes, No, I think he's a mom to

Unknown Speaker 9:22
know they're just film right across the street from us.

Unknown Speaker 9:24
So then this went through a whole conversation where I'm like, I think you're thinking of the guy from The Three Stooges movie and

Scott Benner 9:32
right, so we're going back and forth the living room and having this like conversation. I'm like, Kelly, you're wrong. So we whip it up and we look and she goes, Oh, you're right. I was like, I know it. Is. It made me think of if you ever heard Kevin Smith speak he's like everyone always calls me Kevin James it mean it gave me the same feeling.

Unknown Speaker 9:51
Anyway,

Unknown Speaker 9:53
I so I want to understand the the web series a little bit is it Where can I watch it First of all, and what's its intent You can go to my type two transformation calm. And it lays out an option for you to have a tool for every part of treating diabetes, type two diabetes, there's an exercise program that's specifically designed and it has three levels, there's an easy, intermediate and hard, you kind of work your way up through that. So you can start anywhere, you don't have to be an athlete to start, you know what I mean, you can, there's simple exercises that get you moving and to get you into you build your strength, and then you move to the next level. There, we have a chef on there showing different kinds of diabetes friendly recipes that actually taste good, because, you know, when when you think you got to eat healthy, everything's chicken and broccoli, and then you snap it. So this is a bunch of wonderful options on how to cook flavorful, healthy foods, that, that help keep your type two diabetes under control, then there's the medication aspect of it, all the information is on the mind type two transformation website. And then we even had life coaches come in about shifting that thinking about accepting this thing, and about understanding that this is something it's a disease and has to be managed and the acceptance of that. So showing that journey, I think, like I said, My hopes are, that someone will watch it and go, who was who was thinking, you know what, I'm just going to ignore this, someone sees me doing it and goes, you know, what, if he put himself out there, then I can go investigate this with with with my physician.

Scott Benner 11:29
So let's hit on a couple of those things. Because food habits are huge, right? Like, sometimes you think you know what I mean? Like, you figure it Look, type two, part of it has to be, you know, I'm sure it's genetic, and, but it's also exercise, and it's food, and it's all that stuff that got you there. So the point is, your brain works one way around food, and then all of a sudden, somebody tells you, they can't do this anymore. That doesn't mean you just flip a switch. And because you would have done that 30 years ago, if that was possible.

Unknown Speaker 11:55
Absolutely. You know, I you know, I've gotten away with being a big guy my whole life, you know, but you cannot run a fact, and you cannot run a number. And, and the shift in food, you know, I came from a house where it was like, you know, we had a bad day, let's see, we had a good day. Let's see. So, you know, and I'm also from that generation where it was like finish your plate, right? people starving and other parts of the world, finish your plate. And, and that's, you know, that's wiring, you can't undo, you know, 30 years of wiring and two weeks. So it's a gradual progression, I still don't do it perfectly, but I'm getting better at it every day. Because, again, accepting it and dealing with it. And like I said, The thing I like about this program is you go online, and anything you need is there the tools for cooking tools for exercising information about medication, and and then about, you know, the shift in your brain that you have to make because I have always had an unhealthy relationship with food. You know, I've got you know, pizza is not a reward and Apple is and it takes time to learn that when you're a big guy, you know, people who have never struggled with their weight, don't quite understand that. They just want to tell you this data, seaweed chip, what doesn't work that way, how long? How long did it take you before eating in that way didn't leave you hungry? You know, I'm still not perfect at it. But I would say probably the better part of the year, you know, and I still mess up once in a while. And again, it's it's about progress, not perfection. So, you know, I know to get right back on my horse, like whereas before, you know, if I was trying to watch my food, and I had a bad meal, well, then I was having a bad meal for three months, and then finally getting started again. And now I've just kind of learned that if you do mess up, okay, you know, you lose one game, but you maybe win the series, so you get back on it for the rest of the week. You know,

Scott Benner 13:45
I taught myself um, I'm not a lean person. And I taught myself I used the baked potato fast at Penn jillette talks about sometimes. I don't know if you've ever worked on it. So he just you just eat these baked potatoes, as many as you want. It doesn't matter and what you learn over the first couple days or what I learned was first of all, I don't really like baked potatoes. I like butter and salt.

Unknown Speaker 14:07
And the the mass

Unknown Speaker 14:08
of potatoes with nothing on it

Billy Gardell 14:11
yet. Yeah, nothing. It's terrible. And so, so you eat it. I'm Irish and that doesn't sound good. fills you up. And it's got enough nutrients in it. So I do this thing one time and I lose 15 pounds in like seven days. Wow, it was insane. And I and but I I walked away from it thinking, you know, by the third day, you're like, I don't want a potato. And I'm not really that hungry. Yeah. And it rewired sort of my taste buds. It was really interesting. I found when I really cut out eating sugar and white flour and stuff like that, like once you get off it takes a week or two to really adjust to that. But once you get off and you start to feel better, you don't feel as bloated. You don't feel as swollen or lethargic. And then you you realize what that stuff's done to your body. Yeah, it's And then once once you have that moment, I think it helps put a little wind in your sails. I agree. How was it? Or I guess, how often do you test your blood sugar? And are you considering a continuous glucose monitor? I do I do every day just because I like to see where my number is and make sure that I'm, you know, that's a that's a, that's a wonderful thing to be able to check your blood sugar every day. Because you can, you can realize, okay, well, what did I yes, should have made it go up like, and it's funny, because everybody's different, everybody's gonna have a different reaction to everything, like, pasta doesn't really mess with me, but I just stay off of it. Because I don't want it to trigger another kind of carb. But like, you know, you learn, okay, I can have an apple and not too much happens. But if I have a banana, my numbers go up. So you kind of It's a neat way to learn how to track what it is that affects your blood. And that way you can try to keep your numbers consistent. Yep, I'll tell you, if you ever interested there's something called the Dexcom g six. It's a continuous glucose monitor, you'd wear it and you would see your blood sugar direction and speed. Constant. Oh, wow. It's really cool. You'll see it on your phone, what they call Dexcom g six, it's a continuous glucose monitor. My daughter wears one. It's how we manage her insulin. It's fantastic. So important, man. And and like I said, being able to check those numbers every day is it's vital. You know, it's like checking the temperature gauge in your car.

Scott Benner 16:19
Yeah. So I have one last question for you. And then yeah, I know you're on a short timeframe here. The idea of sharing with your spouse. So I know a person who was diagnosed with type two diabetes, and didn't tell their spouse for a decade, thought him thought it made him look weak, was embarrassed that this whole kind of thing. And sometimes people want the support of a spouse and sometimes they don't. I was wondering how you're integrating your family into what you're doing?

Unknown Speaker 16:48
Well, you know, I immediately told my wife, you know, we've been to we've been together 20 years from now I've been married 18. So there's nothing we don't talk about. You know, but I can understand that kind of mentality where you think, Oh, it's weak. But you know, what I've found is I've gotten a little bit older is, you know, being tough and hiding something that's wrong with you does not make you tough, it makes you suffer. I think that real strength is saying, you know, I need help. I don't know how to do this. Can you help me? I agree. And and my wife was incredibly responsive. She got rid of everything that tasted good in the house the next day. I said to my wife one day, I was like, I know you think that candy looks nice in that bowl at Christmas time. But could you please not put it in there? There's more Hershey's Kisses. You can put a hand chopping machine in front of it. I'm still going Oh, see, you and I might be the same person. Just like I'm looking at it. I'm like, I'll take one. Look how small it is. I've never even one of anything. It's like when you see on the side of a package of cookies serving size Three, two weeks, three, three cookies. You don't deserve to have.

Unknown Speaker 17:56
Those cookies aren't meant for you damn it.

Unknown Speaker 18:00
Oh my gosh.

Unknown Speaker 18:02
If I can take one more second from her. Yeah, you have a new TV show. And I was wondering if you could take Tell me a little bit about it. Sure. It's called Bob hearts abishola. It's on CBS Monday nights at 837 30 Central. And Chuck Lorre show. And it's very kind show, which I think people are thirsty for these days. And it's a sweet little story about a guy who owns a compression sock factory and a business and has a heart attack because of the stress of his own business. And when he wakes up, there's a nurse there abishola and she's Nigerian descent. He's got this strong kind presence that Bob has kind of taken by and he decides in that moment, even though they're very different that you know what, I'm just going to see if this woman will give me a chance. And I think it's something we can read for nice. Do you do you chase after her with the same stuff you bug your wife with?

Unknown Speaker 18:58
Now, you

Billy Gardell 19:00
know, I think all the married writers kind of contribute to that. So I think we all kind of have that collaboration as writers, the writing is so good on this shows, you don't really have to add anything you know, you just wait for the scripts to come really cool. Well, congratulations. It's a It's amazing. Thank you, man. I've seen a recent picture of you. You obviously are on the right track. Would you mind sharing with people? How much weight Have you lost since you were diagnosed? You know what, man, I haven't been watching the scale. So I know that I've taken a chunk down. I used to be the guy that was on the scale every single day and I haven't looked in about seven months. That's amazing. I gotta tell you, it's kind of freeing. I'm just looking and I'm moving better and my clothes are fitting better. And that's what I've been going on. I'm almost at the point now where I'm superstitious to do it. Look at that. Yeah, I mean, just as a person who just sees you obviously through a screen, and it's obvious to me. Yeah, and that's, I like seeing it that way rather than going I went up to I went down three, I went up four I went down. So I kind of got away from that and just started doing what I was supposed to do. seeing the results, like you said, seeing it on camera or seeing it in the mirror, you're like, Okay, alright, that feels better. That looks better. Let me just keep going. It's a healthy attitude. Would you say your mindset is completely changed around your health in the last year? I would say it's on its way. And I'm really glad because I, I'm a stubborn guy, you know. So it's, it's been nice to have this change happened. Very cool. Give me the web address one more time for the series. It's my type two transformation.com.

Unknown Speaker 20:28
Really, thank you so much for coming on and doing this. I really appreciate you taking

Scott Benner 20:30
Thank you, my man, keep doing what you're doing and my best your daughter and I appreciate it. Take care. Okay. All right. Ladies and gentlemen, that was televisions Billy gardell. Billy, by the way, also does a lot of stand up. You can find out more about his tour schedule at Billy gardella.com. It's ga r d e Ll Billy gardella.com. And to find out more about my type two transformation, just go to my type two transformation. com Please remember that the podcast does not exist without the sponsors. And today's episode was sponsored by companion medical makers of the in pen. Those of you using multiple daily injections or just one of those regular old dumb pens, you should upgrade to a smart pen. I think you'll find that in pen is very affordable and will add a level of control to your life. That is probably so far alluded to companion medical comm check out the pen.

You know I have a little music left here. So let me say I really enjoyed hearing someone's perspective about type two diabetes today. I genuinely believe that type two does not have a bright enough light shined on it. And that there are so many people living with it or living undiagnosed. The information really needs to get out there. So if you know somebody with type two diabetes, share this episode with them. Maybe hearing Billy share so openly about what it's like to have tight to will help someone else to not be so scared to share to ask a doctor to ask a friend or family member for help something to reach out to feel like a sense of community where there may be isn't one

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Links

Billy Gardell online

Mytype2transformation

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