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Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

Filtering by Category: Pre Bolus

#289 Wylde and Super Cruisey

Scott Benner

Fiona Wylde will amaze you!

Fiona Wylde is a competitive windsurfer, surfer, stand up paddler and type 1 diabetic who use the InPen insulin pen.

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Fiona Wylde on Instagram

Check out the InPen from Companion Medical

+ 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
Welcome friends to Episode 289 of the Juicebox Podcast. On today's show, Fiona Wylde will tell us all about her professional paddleboarding and surfing life, and her really weird graduation day diagnosis. This episode of The Juicebox Podcast is sponsored by companion medical makers of the in pen. To learn more about the pen, go to companion medical.com. When you get to companion medical.com, you're going to learn all about the in pen. It's America's only FDA cleared smart insulin plan, plus an app system. It's going to help your CGM talk to your insulin pen, talk to a wonderful app on your phone that's going to tell you about things like insulin onboard the temperature of your insulin, and a lot more you'll hear more about it in the show. But if you're on MDI or you're thinking of moving them di I think you want the companion medical comm

I'd be lying if I told you I knew a lot about competitive paddleboarding and surfing. But feeling a while does and I talked to her about it, along with her Type One Diabetes diagnosis and how she manages or type one while she's doing this sort of on that sort of, but there's really intensive activity, always in the water to you know, so kind of seems like it doesn't match up. But field a really makes it work. 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 for becoming bold with insulin.

Fiona Wylde 2:19
My name is Fiona while I am 22 years old, I live in a really cool place called Hood River, Oregon. And I was diagnosed with Type One Diabetes when I was 18.

Unknown Speaker 2:29
On my high school graduation day.

Unknown Speaker 2:32
Oh my god.

Unknown Speaker 2:35
Yeah,

Fiona Wylde 2:36
yeah, it was a very exciting morning and a very terrifying afternoon. But um, you know, sometimes those things just kind of come together like that, I guess?

Unknown Speaker 2:45
Well, I don't know about that.

Unknown Speaker 2:48
That's the way I tend to look

Scott Benner 2:50
that But anyway, my graduation day, I was just like, I see my dad's not gonna come. That's about it. Wow, they were divorced. And I didn't think he was going to come. But then I kind of thought he was going to and then I didn't and then I gave up on it. But the good news for me is that I did not have an incurable disease when that was over. Like, like happened to you. So I want to hear about this for a second. Um, so you're only 22 and you're dying. you're diagnosed for about four years ago? Like Actually, yeah. I was gonna say a little more. Right. So prior to your high school graduation day, was there any indication that something was amiss with your health?

Fiona Wylde 3:27
Yeah, for about the six weeks leading up to that I did Online High School the last three years, because I was already competing and traveling and need to define it a way where I could get my education while still, you know, traveling to all these different strange places all over the world. So I found online program that worked for me. So my version of a high school graduation day isn't necessarily like everybody else's, because pretty much for me, it was like, okay, completed all the coursework that, you know, was titled, and getting a high school diploma. And then it was like, you know, I'm done kind of thing. And, you know, my parents were awesome. They wanted to make, like, you know, a little deal out of it, because I hadn't worked hard to get there. So I just remember, like, running downstairs. So I was like, as long as I'm like, I finished I don't have any more work I can do. Like, you know, I guess this means that I, I'm done. And she was like, wow, you know, super excited, really happy for me, you know, I've been feeling off the last few weeks, I had gotten my first contract and signed my first contract the following or the previous fall.

Unknown Speaker 4:30
So when I was 17,

Fiona Wylde 4:32
I got my first contract from Star Wars standard powerboating, which they're pretty much the largest company that creates wind and water sports equipment in the world. So for me, it was huge. And then, you know, my mom was really pushing me to go to college, but I wanted to try and do this and just see where I could take it and why not and kind of when I signed a contract, it was only a year long contract, but at the same time, it was going to allow me to financially support myself through university Competition. So I was like, Okay, I'm gonna do it. So, you know, I had obviously had to finish my senior year. And then I was gonna have a year to dedicate it to the sport. So I had a couple races, I had a race in April. And I was like, out in front doing amazing. This is like my first big race, kind of, you know, to show ourselves that, you know, deserving of the sponsorship and wanting to push it. And I was in second, like, all the race, it was a 13 mile race. And on mile 12, I went from second to sixth. I just hit a wall, something happened. And I was like, what, you know, I was so frustrated because I had it, you know, I had the podium doing super good. And you couldn't figure it out. And so I was like, Alright, well, you know, that really sucks. But okay, I need to train I need to, you know, figure out more things. And so I came back. Actually, no, I didn't come back home. I did two more races. I did a race the following weekend. And the follow up after that. And each week, and I was just feeling worse and worse. And I was like, what is going on with this? Like, you know, okay, instead of joining like in between the races, I'm going to rest now and see if that makes it better. Yeah, that that went on for about six weeks. And then it was my school graduation day.

Scott Benner 6:11
Oh, my fairy. You've said I have so many questions. There's not enough time. Okay, so I need everybody to slow down take a big deep breath. Okay. And and let me pick through what just No, no, no, because none of what you said was my expectation. Right? So So, okay. When did you start? Okay, I don't even know how to ask this question. So you are a competitive paddleboard? Or is that what you would call yourself if if, like, okay,

Fiona Wylde 6:39
you professionally and stand up paddling. I used to compete professionally and windsurfing as well. But now I pretty much focus on standard paddling. But I don't just compete in the one aspect I compete and stand up paddle surfing and stand up paddle racing. So there's two different world tours for that, and I compete on both sides, and

kind of one of the only few that competes some

Scott Benner 7:02
bolts that like an actor who's in a Marvel and DC movie. I see what you're saying. Yeah, so and and I done a little bit of my homework to try to figure this out. Right. So what is happening here there's a phone that's not supposed to ring. That's right. Here's how I want to begin. Most people listening who think about sports with younger kids are imagining like travel soccer, or travel baseball or softball or something like that. But obviously, you know, unlike most of us who can travel to a field, you need a body of water or, or surf I would imagine so what what how old were you when you started doing this and how did it begin?

Fiona Wylde 7:38
It all started with wind surfing for me. My parents were wind surfers and I grew up when surfing with them didn't have river we have amazing conditions here where we can go windsurfing, and surprisingly I don't actually live on the ocean. I live about three hours inland. Okay, the cool thing is I live on the Columbia River which is about a mile wide and some places and you know it's the headlands are up in the headwaters are up in Canada. And then they flow down through Idaho and then through the Oregon Washington border where the river enters the Pacific Ocean.

Scott Benner 8:13
Is this river where you do most of your practice.

Fiona Wylde 8:16
Yes, so this river is where I do pretty much everything and from windsurfing, stand up paddling. The only thing you can't do here is you can't surf. So for that I have to get a bit creative and just drive or fly or go some other places for some training.

Scott Benner 8:32
Okay, everybody, just I feel very overwhelmed by all the new things I know you don't need to be sorry, this is me. I'm not prepared.

Fiona Wylde 8:41
But no, no, but to answer your question. So I started with windsurfing. And I started competing in windsurfing, when I was like 11 I did the local races here in town. And then when I was about 13, I got some experience in the waves. And I was like whoa, this is so cool. I did a trip with my dad. And I was just like, this is absolutely amazing. I want to you know, learn how to win surf wave sail more. And so at the time, there was kind of this revamp of the wind surfing tour is called the American wind surfing tour. And it went all up and down or all North America and then eventually ended up going to South America as well. And so then I pretty much started doing that from when I was like 13 until I was about 19 and that experience of you know, learning a new sport in a competitive environment. got me into I don't know it just got me into all sorts of situations that I've had experience from that have taken me you know, to where I am today. Like I went to go to different countries. I got to travel with friends. You know when I I think I did my first trip without my parents when I was 14

Scott Benner 9:59
what the necessitates you going on a competitive trip without your parents? Is it just they're working? Or actually before I asked you that, so what would you kind of relate what you're saying to me to somebody out there who's listening who's like, Oh, my kid played like little league baseball. And then they got really good at it. So they started traveling to play it. And then they know somebody was interested. So they ended up going to college and playing is that like, it's so there's no college for windsurfing. I assume there's no maybe. Why not, by the way, but okay.

Fiona Wylde 10:34
There are some college. Yeah. For windsurfing, navasana, paddling, really? Okay. Yeah. So, so yes, in a way it is, it would be similar to that, you know, you kind of start at the beginning, you have a couple results, you kind of want to push yourself a little bit further and see kind of what that next challenge is, you know, and then I quickly got into the part where I like, Okay, I'm competing for, you know, the title of the tour. And so that is what made me travel more, because then it's like each event, you get certain points. And honestly, like, my parents have been awesome. They're never like, it's not about the result. It's about having fun and learning things. And kind of with that mindset, and that they've taught me since I was so little, it's been easy for me to just go and be like, okay, like, even if you completely bombed something, you're still going to be able to learn something from it. And actually, you're probably going to learn more than just from winning it. So, you know, the first few years, I didn't really win. You know, I want some events, but not consistently, or this and that, whatever. But the cool thing about the whole Windsor tour is, well, it's wind related, and there would be many mornings, because places typically the wind picks up in the afternoon, where we would have waves. Or we would have wind, and a few of the people there had stand upon awards, and that is one that's the side that I got in choose to stand up paddle surfing, was through this wind surf tour.

Scott Benner 12:00
Yeah, you made your own wind with the paddle.

Unknown Speaker 12:02
Yeah. But like when there wasn't the

Fiona Wylde 12:04
wind for windsurfing, I still wanted to go in waves because I live, you know, three hours from any kind of surf. So it was like, Okay, this is my chance to take advantage of it.

Scott Benner 12:14
Gotcha. All right. Okay, that'll make sense I'm doing. I really feel like I'm starting to catch up. Now. It's funny. I don't know if you heard me. I talked to Kate Hall a few weeks ago. And she's, you know, trying to, you know, to jump in the Olympics. And it's funny, because like she started talking about, like, some of the steps she had taken was like, Oh, this is where this sport sort of ends up differing from other sports. And when you say there's a tour for like windsurfing, for instance. It's not it's not you and six other windsurfing, kids who are all like always at the same thing. There's a lot of people at these events, right? Like how, like, how big are the Yeah,

Fiona Wylde 12:47
um, well, that's also a good point, too. There weren't really that many other kids, I was kind of one of the only kids within the windsurfing side there, you know, there may be like, you know, three of four of us kids or something like that. And then there's, you know, over 200 people in an event. So that was also cool, maybe grew up kind of quick. You know, being the only one there like my best friends are 1012 years older than me.

Unknown Speaker 13:12
And the same thing with stand up paddling.

Fiona Wylde 13:14
Most of the women that I am competing against and the races at the elite races, I think the girl who is closest in age is six years older than me, on the international stage, so I'm definitely one of the youngest racers at the moment, which you know, is changing, which is good, because we're having some more girls coming up. But within the standard panel events, it's pretty awesome. Because it's done upon events, we can get like 500 people to the race on a weekend, the elite field might only have like, you know, 50 but with the open competitors, then you have you know, mass quantity, which is spectacular.

Scott Benner 13:50
What do you what are you competing for, like when I say that? I mean, like I realized like when, when Mike, I've used my son as an example, right, like, so when he was really young, he just was playing like you said baseball to get better, right? And when you're playing High School, and you're trying to get better and then but at that point, now you're trying to prove to somebody that they should take you on a collegiate team, like it's trying to prove yourself like, and then when you while you're playing in college, you're hoping that you continue to grow and maybe somebody will draft you like that's the pathway when you're when you're competing. Are you competing for a trophy? Are you competing to turn to those people and be like, hey, how high one? Or like, what's the next step? Is it personal fulfillment, or is there something beyond that that you're shooting for?

Fiona Wylde 14:33
For me, it's definitely you know, pushing myself I'm in a comfort zone but then also outside of comfort zone and the see kind of how far my skills and fitness will be able to take me as well as controlling my diabetes along the way. But the reality is there's three tours that I ended up competing in the near the ATP World Tour for surfing, ATP World Tour for racing, and the European Championship tour. The start of my year basically starts in Europe. The spring, I ended up racing in five, six different races in Europe. And that is pretty much the best of the European centripetal racers in the world, plus many international riders. So there's people like myself from the United States that come over from Brazil, from Canada from Australia, pretty much everybody the sport focuses on the racing in Europe during the spring. And so that was about six weeks of racing and touring. And I ended up winning that this year. So pretty exciting. So yeah, to win the Euro tour, you have to have five really good results in order to go towards your final tally. And I won five races. Congratulations. Thank you. Yeah, for me, it was quite a quite an exciting thing, something I didn't really think that I could win, but I was able to do that. And then on the other side with the surfing and the ATP World Tour, you're competing for a world title. So within surfing and racing, they're two separate competitions. But I won the racing world title in 2016. And I have not won a surfing round title. I've been second a few years, but I haven't won yet.

Scott Benner 16:14
So basically, it's it's it's sort of broken up into two areas, like it's your competition, and just trying to be good and test yourself. And then the other side of it is I'm assuming if you're having good results, you'll start getting sponsored by companies, those companies will pay you to use their boards or something like that. And then that's how you can kind of finance your ability to exactly I see.

Fiona Wylde 16:35
Going back to kind of what I was saying at the beginning. I'm the year before I graduated, as I graduate in 2015. So fall of 2014. I got sponsored by star board, which is that big company, so they pretty much were like, okay, you're young, you're getting really good results. We want to support you to paddle our boards to go all over the world to continue to get good results and promote a good image for our brand, right? Because when because when Fiona comes cruising across the finish line on a star board, people there are a lot of people there and you stand up and hold the board and they're like, hey, Star board, that makes sense.

Unknown Speaker 17:12
Yeah, we get on the

Fiona Wylde 17:14
podium, they get all the accolades, everything like that, that helps them and it helps me as well.

Scott Benner 17:18
You're the you're the paddling equivalent of like a YouTuber or like, or a guy who plays video games and makes a living at it. We all like go. Did you hear about the guy who makes a million dollars a year to play a video game? And

Unknown Speaker 17:31
don't quite make a million dollars a year? Oh, no,

Unknown Speaker 17:33
no, no, I didn't mean I didn't mean to say that. A lot of questions like Oh, that's cool.

Unknown Speaker 17:37
I didn't even know you could compete in those things.

Scott Benner 17:40
It's it's a it's a very uniquely American economy story. it you know, it really is your 14 years. Now, when it was first happening when you were younger, was it just sort of like you, you know, you would imagine like hey, my dad played soccer in high school so I play soccer was just my parents when surf and so we wind surf together and then there was a place for me to do it competitively. So I went and did it.

Fiona Wylde 18:04
Yes, um, that was for the windsurfing side, but not for this on the public side because that is relatively new for you know, it's been around now more than she's blowing around like 15 years or so. And I got into it with one of the local shops here in town and they wanted to create a kid's team and so I was one of four journal

Unknown Speaker 18:25
kids and that was

Fiona Wylde 18:28
nine years ago and that was how I got introduced to standard pedal racing. And that program is still going on my dad then learn how to stand up paddle after I was doing it because I was having so much fun and he wanted to do with me and the cool thing is about that kids program is it's still going on and this last summer I got to coach the whole program so that was pretty cool returning

Scott Benner 18:51
starter coach the theme absolutely I it's it's crazy in my mind I imagine like a bunch of wind surfers standing around on a day when the wind doesn't blow and one of them going well do we go home or what are we doing somebody like if we had a paddle and we're just like oh my god a paddle changes. So now I have to tell you that I hope you understand that most people listening when you describing either surfing on a much bigger because it's a bigger board right when you write or your paddleboarding like I if you told me right now, Scott go out into the river, the one feeding from Canada and stand stand up on a paddleboard and say standing on it for let's say 10 seconds and I'll buy you a house. I would not have a house when the day was over. Right? Like I would just be like, I can't I can't accomplish that.

Fiona Wylde 19:46
I would be nice. I mean, maybe if I had to buy your house, I'd put you on like the most narrow board I could find.

Unknown Speaker 19:51
Yeah, right, right. Cuz you're

Fiona Wylde 19:53
like, Okay, let's go out you know, for an ice cream or whatever be like excellent. I'll put you on the biggest board. You know, you Start, it's just like anything. When you're learning to ride a bike, you have a different kind of bike than, you know, a professional cyclist.

Scott Benner 20:07
You're telling me if I had the right tools, I could stand up on a paddleboard?

Fiona Wylde 20:10
Absolutely, that's the cool thing about it, anybody can do it, you know, you can, all you have to do is you just get a bigger board. So I race on a board that's 14 feet long, 21 and a half inches wide, and you most likely wouldn't be able to stand on that. But if you were to go paddling for your first time, I would give you a board that, you know, is maybe 12 and a half feet long and 30 inches wide.

Scott Benner 20:37
Either you're gonna say 12 and a half feet wide, because it's got we're gonna throw up a picnic table out on the end, you'll be now Be honest with me, I'm 48 years old, How far would I paddle before I had a stroke or an aneurysm? A couple of feet? A couple minutes? How far do you think I'd make it.

Fiona Wylde 20:54
So you can go as far as you want to go? That's a good thing is that you know it, it doesn't really matter. You don't you know me, okay, if you were to, you know, jump off the start line and try and go sprinting, you'd probably be out of breath kind of soon. But you can jump on a board, you can go with your friends, your family, if you have a dog and put your dog on the board go cruising around, like,

Unknown Speaker 21:16
there's all sorts of different things you can do.

Fiona Wylde 21:18
It's like, it's like a bicycle, you know, you have your people who go out and ride 100 miles, you know, in the weekend, and that's what they do for fun. And then you have some people who have cruiser bikes, or even ebikes that you know, put a picnic basket on the front and go, you know, cruising around, paddling is the same in that sense. Like you can, you know, have top line race equipment, go, you know, for speed, or distance or whatever. Or you can just grab more of a cruisee board and go have fun, go exploring, maybe you know, paddle into a different place that you've never seen before. Or, you know, it's cool to paddle out and look back at what you're looking at every day, see and just get a different.

Scott Benner 21:58
No, see, you're saying this is where people like you who are super athletic, don't understand that other people don't have brains like yours. You're saying I would paddle out to get a different perspective, which does sound neat, except I would paddle out and then have a panic attack that there's no way I can make it back again. And then I would start imagining what giant Canadian fissure in the river that will eat my body when I sink to the bottom. Like that's, that's how it would occur to me.

Unknown Speaker 22:22
Yeah, that just crossed my mind.

Scott Benner 22:25
Wouldn't it be great if if Fiona's entire career was killed today as she can't get over the anxiety of thinking about whether or not salmon could eater? And she's like, I never thought of it before? I can't go back and

Unknown Speaker 22:40
yeah, I'm okay. All right. Yeah. Okay.

Scott Benner 22:42
All right. So So, so first of all, it's amazing. And you said something a while ago already that I jotted down and I don't make a lot of notes when I do this. But did you say that there was a paddleboard race? That was 13 miles? Yeah. Okay, so when when they say go, first of all my I have questions. Does everyone finish? You start?

Fiona Wylde 23:06
Um, pretty much in the elite field? Yeah. Okay. In the open field, there might be a couple that pull out. But, um, it's just, it'd be more like a marathon in that sense. You know, it takes a while. Some people, some people, you know, don't, maybe some people just get tired or fatigued. And then yeah, you have to pull out for that. But for the most

Scott Benner 23:28
part, especially within the elite field, pretty much everybody finishes how, how long does it take to go? Like, like, the person who wins? How long does it take them to go 13 miles.

Fiona Wylde 23:40
With that particular race, too. That's the other thing with water, it all depends on the conditions. If you have 13 miles with wind at your back, and you're going what we call downwind, which you can kind of surf little bumps that the wind is generating the whole time, you're gonna go a lot faster than if you have a headwind or completely flat water. So it depends, but in that specific race that was in North Carolina, around Wrightsville Beach, and that was about a two and a half hour race.

Scott Benner 24:10
So I'm going to tell you that I'm not 100% certain I could stand on the board for two and a half hours. Like take all the retrace Where's a

Unknown Speaker 24:17
lot of training? I'm not kidding. Like,

Unknown Speaker 24:20
aren't you legs like super tired?

Fiona Wylde 24:22
Your legs are exhausted? Yeah, most people think that all paddling comes through, you know, your arms and your shoulders and all that, but there's so much balancing involved. And your legs are your bigger muscles. So you might as well use them more. So by the end of it, my legs are shot.

Scott Benner 24:34
Yeah. And you're not strapped into the board, right? Like you're free balanced on the board. So when you when you drive with that paddle into the water, you really are anchored by just the grip of your feet on that board. Yeah, exactly. Yeah. See, I'm starting to really think about this now. And as bad of an idea as I thought of this. At the beginning, I'm thinking it's even worse idea now that I'm really thinking it through but because at least if you were anchored to it, you don't mean like you You didn't have Like a fulcrum point that was like fixed and now you're but you're basically like digging in, like while you're doing that to do you lean forward while you're paddling, do you stand straight up? How does that how did you

Fiona Wylde 25:10
lean forward, you lean forward and you have a lot of bend in your knees. So you can have that drive. And kind of what you're thinking about would be more similar to like paddling a canoe or rowing in the sense because then you would have a fulcrum, you know, coming from your hips because you're seated, but because we're standing up, you really do have to use your legs and it actually is beneficial to be able to move your feet around the board.

Scott Benner 25:35
Okay, so you can kind of reposition, so you can stability, and I'm imagining drive from different angles for steering purposes and things like Yeah, exactly. Yeah, look at me. You got it. Intellectually. I understand what is getting narrower. Now we can give you like a 28 inch wide board out of your mind. I saw jaws when I was five. I'm not getting in any water on a board. Okay, so and I know there's no shark in that river and I don't care

Unknown Speaker 25:59
why it's fresh

Scott Benner 26:00
water. doesn't listen, if someone would have taken you to jaws in the 70s when you were five years old. By the way my parents a huge mistake. I you would you would have the same concern I have right now. You'd be like no, but that mechanical shark will eat me. It's so okay. I'm seriously there's people my age right now who got drugged into that movie are like yeah, damn right, man. There's no reason to go into the water. Okay, so 1313 miles over two and a half hours. And do you know for that specific race, the person who finished dead last how long it took them? It

Unknown Speaker 26:34
took them about three and a half, four

Scott Benner 26:36
hours, another hour and a half for me. Oh my goodness. If you want to quit someone comes gets you just raise your hand and start crying. What happens? What do you do?

Fiona Wylde 26:45
There are support boats that are you know, all up and down the course and jet skis and all that. So that's, that's good. That's important. Safety is huge, you know, being on the water. Yeah, so there's all sorts of different watercraft that are kind of patrolling the area. So you know, the best thing to do in any situation on the water, if you're in trouble is to sit down on your board and stay with your equipment. She is the thing to float on. And then you can wave your hands over your head.

Scott Benner 27:10
I have a good friend who lives on the water in North Carolina and she paddled. I think she paddleboard is pretty much constantly. And I know she heard this, she'd be like, you could do it like that. I don't think I can. Okay, so now,

Fiona Wylde 27:22
all races are that long. Um, we compete in all sorts of different types of things. There's different races, like surf races, where you go in and out of the surf, there are distance races, which are pretty much anywhere from like, nine to 13 miles. There are flatwater, bumpy ocean, pretty much everything. There's some races that are more like 4k races. And then there's even races that are like 200 meters. So right now I'm training actually for a 200 meter race, a 4k race and an 18 k race, what's training

Scott Benner 27:57
look like? How do you train.

Fiona Wylde 28:00
So for me, I'm actually really lucky right now to have three weeks at home, this doesn't happen very often.

Unknown Speaker 28:08
So

Fiona Wylde 28:09
I've basically broken down the three weeks I have into different training days for a specific goal. So if there's something I'm going to China for the ICF World Championships at the end of this month, and so the first day, I will be competing in 200 meter sprints. The second day, I'll be competing in the, like a 4k technical race. And the third day I'll be competing in an 18 kilometer distance.

Unknown Speaker 28:35
So

Fiona Wylde 28:36
when I take a look at that I look at Okay, what are my strong suits and what are my weaknesses. And the weaknesses are what I focus on in the training leading up to it. So I've broken down each week into basically, six out of the seven days, I'm on the water, doing different drills and intervals and workouts that are building up on certain weaknesses. And then I have Monday, which is today, which is my like, complete off day. So today I will be on the water. I won't go wrong or anything like that. And it's been fun. It's been fun too. Because it's it's hard. It's hard to focus on something that you're not really that great at or you know, even if I'm decent at it, it's definitely, you know, I'm not as strong as my strong suit. So and I'm learning a lot, that's the thing that's crazy. It's like, okay, even if I'm, you know, leading the tour at the moment, or in the top three or whatever, like, you know, some people would be like, Oh, well, you got it. And it's like, No, you can constantly be learning new things.

Scott Benner 29:32
It's fascinating. I journey dry land training, like, Is there anything you do in a gym that's specific for this? Or is it really yeah.

Fiona Wylde 29:41
I mean, you have to be on the water. That's pretty much where it comes from, because like you can do all sorts of different fitness to get your base up, but it's also so much technique involved, that you really have to spend the time on the water to focus on that. But I'm I'm going to spend I last week, two days and then this week, two days in the following week. Two days as well in the gym, and that's going over a lot of like plyometric stuff. agility, balance, trying to get fast twitch muscles going faster. And then normally walk out of those days so personally, but yeah, beyond that I liked I love running. So any chance I get to go for a run? I go for a run or bike rider. It's just such a beautiful place that I live that if I can be outdoors, I want to be

Scott Benner 30:25
here. I that's I mean, listen, I'm not. I'm not judging you. I know that I'm just got this guy.

Do you think she just ran outside?

Unknown Speaker 30:43
Oh, you were like, I

Scott Benner 30:44
don't know. You're like I if I can be outdoors, I'd love to be outdoors. Then it hung up and I thought maybe she just probably went outside

Unknown Speaker 30:53
my computer just on black.

Scott Benner 30:55
So sorry about that. No, no, no, no, it's it's, you know, it's absolutely fine. Don't don't think anything of it. I okay, so I think I understand. I mean, listen, I understand academically, all that what you've explained to me and even though I'm still in my mind thinking, am I gonna ask her about like doing this to the ocean? Like, do you just paddle out and then ride and like you're surfing but you have a paddle with you? Yeah, pretty much. Okay. So what's the difference between surfing and paddleboarding in the ocean?

Fiona Wylde 31:25
When I go and I compete and surfing, you know, the big difference is when your traditional surfing, and you are, you know, land down on your stomach, you don't have a paddle in your hands, and you're prone paddling, so you're on your belly before you pop up. My board looks a lot like a surfboard. And most people would say that is not a stand up paddleboard because it's really small. So my standard puddle surfboard is very small, because it just has to be thick enough just have to have enough volume. So I can stand on it without falling over. So then I basically I'm paddling in already standing up when I catch waves. But like, for example, most people you know, a shortboard on like a five, eight or 510 or something like that. My standard paddleboard is seven oh, and when I stand on it, it pretty much thinks

Scott Benner 32:18
underwater. Okay. I would like you to do something for me if you ever can teach yourself to do it. While you're surfing, I'd like you to reach up with one hand and spin the paddle with one hand over your head like

Unknown Speaker 32:30
you would be surprised.

Scott Benner 32:32
You can do that I now I understand why you have sponsors? Because can you get to that? Do you think or do you think it's not? I think I

Unknown Speaker 32:41
might have done that a few times.

Scott Benner 32:42
No kidding. See? That's excellent. And that that I would just be like, that girl wins. And like, no, she's actually in fourth place effect. No, it doesn't matter. Look what she's doing with this file. Yeah, there are no points on this.

Fiona Wylde 32:57
Okay. Well, I mean, it's I think it's more about the surfing at that point. But we actually have some inside jokes and some other competitors, where it's a lot of people think that Oh, just pushing the paddle around is what gets you points when in reality, you have to surf. So it's kind of funny that you mentioned that.

Scott Benner 33:14
You've been involved in water sports, so long that you went to high school online, and you came out and now what's your life span like in this? And it sounds like with the people you're competing with? You could do this for a really long time. Is that how you think about it?

Fiona Wylde 33:29
Absolutely. Yeah, so I did Online High School. And then I got sponsored. And my mom was like, you know, you have to go to college, like, you know, and then I got this sponsorship that came with a contract. And she was like, okay, like, one year, you know, let's see where it goes. So that was the year that I got diagnosed with diabetes. And then I was like, Oh, great. Here's my first year of being a professional athlete, somebody or something I really wanted to do and be since I was, you know, super small. And just,

Scott Benner 33:59
yeah, I understand it from a parenting perspective, right? Like the idea of like, Hey, everybody needs to go to college. So once you get a job, and I'm not gonna, I'm not gonna be alive forever. And I need you to know, I need to know you're going to be able to take care of yourself when I'm old and gone. Like I think about that with my kids. So now, now, though, you have a little success. I imagine you must have walked in the house with the first contract held up over your head and said, Oh, who has to go to college? Not me. Because I'm making money. Like, did you run around? Like was it like a rap? It wasn't so

Fiona Wylde 34:28
much like no, so much like that. It was more of like, Look, I got this chance to do it. I will go to college. But for right now, let me just try and focus on this

Scott Benner 34:39
right. I can't argue with it. I can't argue with it. I don't listen, very few people get drafted to play professional baseball and I don't imagine my son will be one of them. But if it but if it if it happened, I would not know how to stop him. Like, yeah, you know,

Fiona Wylde 34:54
it would be something slightly similar to that. Um, so then I was like, Okay, great. Now I have type one diabetes and a professional contract. But I kind of wanted to keep racing and type one just came at the wrong time. I don't think there ever is a right time for it. But it was like, Okay, I'm just going to keep doing this. I'm going to figure out some systems and how to, you know, get sugar with me out in the water, and you know, learn all the feelings. Yeah, it took a little bit. But that year, I basically finished the season. And the next year, I won the racing world title. It's amazing. So then it was kind of like, Okay, this is going well, I

Scott Benner 35:33
can do this. Right. So let me let me pick through that a little bit. So when you're first diagnosed, I'm assuming you leave the hospital with like, like pens or syringes and insulin and a meter. Right. That's about it.

Fiona Wylde 35:47
Primarily, because I didn't really think that anything was, you know, that wrong? I knew I wasn't feeling great. But basically, I just went into my family care doctor. And, you know, I explained that, you know, I hadn't, you know, had dry mouth, I've been losing some weight, you know, I had the infection and this and that, whatever. And he looked at me, and he's like, has anybody ever tested your blood sugar? I was like, no, what, what is that? You know? And I was like, you know, thinking, Okay, all sorts of tests, you know, what's involved? And he just pulled out a meter. And he said, let me prick your finger. I was like, No,

Unknown Speaker 36:21
thank you.

Fiona Wylde 36:23
Okay, and then he pricked my finger. And the number that popped up on the screen was 586. And I was all happy, because I just graduated high school that morning. So I'm like, great. What's that out of like? 1000? Yeah.

Unknown Speaker 36:35
And he goes, No.

Fiona Wylde 36:39
Yeah, I'm really sorry. But you pretty much have type one diabetes. And I was like, you know, tears, and I didn't know what that meant. And, you know, I had no idea what diabetes let alone type one was. But I live in a small town. And he pretty much said, Go home, because I just went to the doctor's office on my own. He was like, go home and talk with your parents. And he gave me his personal cell phone number and was like, have them give me a call. And I can talk and you know, help you guys out if you need anything. So then, that night, pretty much I didn't get any insulin didn't do anything. I actually never went to the hospital. Because I was 18. So I wasn't an adolescent, I guess. More just kind of strange. But, um, yeah. So then I went, and the next day got connected with a diabetes educator. And she went through absolutely everything and you know, explained how insulin works, what diabetes is, and she was spectacular. And she's the one, you know, who showed me how to prick my finger and how to, you know, calculate carbs and give myself insulin for that. And that's when it all started. But the problem was that I was supposed to go to Europe to race for the first time. Five days later, that was like, oh, my goodness, you know, like, the first go diagnosis, I was bummed because I was like, okay, like, obviously, I'm not going to go like, this is not my priority, right? Now. My priority is my health. But then after getting insulin started, and like, you know, immediately coming out of the 500, so it's just good.

Unknown Speaker 38:12
To range.

Fiona Wylde 38:14
We went and spoke with my doctor. And, you know, I was sitting there with my parents, and I was like, Okay, so, here's the thing, like, I was supposed to go to England to race. My dad was already planning on coming with me. But you know, if it's going to be any problem for my health, like, you know, please tell me and I absolutely will not go you know, that's, I don't want to put myself in any harm. And he looked at me and he goes, that is not a decision for me to make a it's not gonna hurt you. So I think you can make that decision as a family. And I was like, okay, we're going to England. And then we got on a plane two days later.

Scott Benner 38:51
And what did you have with you just the Beatles and like a meter. And yeah,

Unknown Speaker 38:54
so I had

Fiona Wylde 38:56
when I went on that first trip, I had lantis. I had cumilla and quick fence, and I had a box full of needles, a box full of test strips. I had a sharps container, I had an extra meter. And I have a lot of gummy bears. All sorts of I found these goo jobs that I could bring with me on the water and my mom sent us on the plane with like, the biggest cooler full of food and snacks and everything it was it was amazing. I'm surprised they even let it on and carry on. It was so big, but she was like you're not going anywhere without food.

Scott Benner 39:36
Probably probably thought you were like trying to start a grocery store in Europe.

Unknown Speaker 39:39
Probably.

Scott Benner 39:41
Well, that's so now looking back. Was that incredibly brave or incredibly stupid? Like when you look at it now do you think knowing what you know now would you have still gone?

Fiona Wylde 39:51
Absolutely. Okay. For me, it was exactly the thing that I needed to do, and needed to hear from my doctor. He knew me he's been my family doctor for ages. And, you know, he's seen what I've done competitively and could also see how, you know, a diagnosis of type one can, you know change your life in many ways. And so for him to say, you got to do what you want to do, and you will figure this out. As you go, doesn't have to hold you back. It was the they were the best words that I could, you know, ever ask to hear without even knowing that's what I needed to hear. Because that just kind of gave me a little bit of confidence to go and do what I actually want to do, which was go to Europe and go race. So do what I love

Scott Benner 40:34
the water joking around aside, I think that's amazing. I I'm a big proponent on the podcast of giving people giving people what they need as far as tools up front, so they can make good decisions. I don't like the idea of slow walking people into the information, let them learn it slowly. Because eventually, inevitably, excuse me, something happens, then you need some information, you don't have it, then the fear starts building up. Yeah. And then before you know it, you're kind of overwhelmed by the fear. And then even when you get good information, it's hard to take it. So I think that's Yeah, really amazing. I mean, for me, my life

Fiona Wylde 41:06
didn't really stop when I got diagnosed with Type One Diabetes.

Unknown Speaker 41:10
I like was up and running, and it

Fiona Wylde 41:12
was just gonna be something that I, you know, have to figure out and continue. You know, I'm sure today, there's gonna be something that

Unknown Speaker 41:17
I'm gonna learn from it. Well,

Scott Benner 41:19
yeah, I'm gonna say something. I'm gonna say something I told Kate Hall. And, and I think it applies to you as well. And I don't know that all the time that people who have that competitive athletic nature, like you do understand that it doesn't exist and everybody else but you know, I use I always use Chris Freeman as my example, like Chris sees like snow and these two tiny skis and thinks to himself, oh, I will ski a long distance with only these two poles to propel me. And you and you look at water and a small board and think you know what I should do go on a 13 mile race on that water standing. There's What I'm saying is, and it's probably not like life threatening, but you have a mental illness and you don't realize it.

Unknown Speaker 42:02
But, but seriously, but seriously,

Unknown Speaker 42:05
don't deny it.

Scott Benner 42:06
Seriously, it's a way of thinking that lends itself to the challenge of diabetes. Like, you know, like, right, you're just you look at the diabetes, you're like, well, I've got I've got these needles and this insulin, how do I get to the other side? And and that's, that's really cool. It's amazing. And it's why you're a great role model for it. So, so tell me when. So now, nowadays, you are a Dexcom user using the G six. And when did that start? When did you get your CGM?

Fiona Wylde 42:35
I got my CGM about eight months after I was diagnosed. Um, and it was the Dexcom for the beginning. And when that thing came out, I was like, Oh my gosh, this thing is the coolest thing ever. Like, are you kidding me? I don't have to prick my fingers. And I actually know my blood sugar is. Yeah, and pretty much I have not not worn a dexcom since then. Um, so yeah, about four years. Yeah, my daughter index common.

Scott Benner 43:04
My daughter's had daily wear to like, wait, she doesn't take breaks from her stuff like that?

Fiona Wylde 43:08
No, no, for me, it's just a safety thing. You know, I'm just being able to constantly monitor and know where my blood sugar is. Helps me and everything. I mean, it sucks, you know, if you go super high, or if you're going really low, it affects everything else you're trying to do during the day. So yeah, just to be able to have a monitor on it and, you know, catch crashes or catch cut highs, you know, before they get to the point where, you know, you get tired or you get exhausted or you have to take time, you know, out of your day to manage your diabetes, rather than focusing on what you're doing. If you know, things like that can be monitored better and alleviated, then there? I don't see any reason why I wouldn't wear one.

Scott Benner 43:46
Yeah, I agree. I have. So I want to I want to use up the rest of our not use up but I want to use the rest of our time to talk about your management because you are in such a significantly different situation than most people as far as like the intensity and the load and the work on your body. Right. And so everyone Yeah, everyone listening, you know, as well, the people listen to this podcast, probably don't think of it the same way. But a lot of people with diabetes would think I can't paddleboard because I'll exert myself, and then my blood sugar is gonna drop and I'm gonna, you know, it's gonna be up and down. I can't possibly do it. So my expectation is, and I don't know this before I asked you that you don't have a lot of variability in your blood sugar. I'm assuming you're not going from 40 to 600 and jumping around like that?

Fiona Wylde 44:29
No, I'm not 40 to 600. But you know, I could have 80 to 200 you know, occasionally 250 or something like that. Sure. Um, I think the you know, before we go into specifics of what I do on the water, for me, exercise helps in every way. You know, even if I am high and you know, I've just been giving myself insulin and haven't been able to go down or whatever, if even if I just go for a walk around the block or like 10 minutes, you know, cruzi or something like that, I will be able to drop my insulin and it just makes me feel or my blood sugar and it just makes me feel better.

Unknown Speaker 45:08
But for being on the water,

Unknown Speaker 45:11
I've been using

Fiona Wylde 45:12
the in pen from companion medical Yep, for the last year, just about. And that has helped me a ton. Because you can actually see how much insulin is still in your system. And you can remember what, how much was in your last dose and when your last dose was, because sometimes, you know, if you're, you know, running around and Okay, it's time for dinner and you give yourself insulin you keep, you know, you're cooking the rest of it, and I'm like, Oh my god, did I give myself insulin. So in fact, is really helped me because I, um, you know, can see how much insulin is in my system. And that also helps me plan for going out in the water. So if I, okay, if I have extra insulin in my system before I hit the water? Maybe I should eat a little bit of something before I go out and paddle.

Scott Benner 45:56
So you got when? Good? Yeah, no, I apologize. No,

Fiona Wylde 46:00
no, no noise. So when I'm on the water, I, this is for racing, or you know, even just for going running, or, you know, anything like that, I pretty much always wear a hydration pack, which has water in it. Because, you know, it's just good to stay hydrated out there. And it has a couple pockets as well. So my impact can go on the back, I take it with me just you know, in case for whatever, I have one pocket that has my phone, and the other pocket that has some type of sugar, like I use a lot of time like Clif Bar good jobs, because they're individual squares, and I know how many carbs are in each square, and how much each square will raise the amount of

Unknown Speaker 46:43
raise my blood sugar. Okay,

Fiona Wylde 46:45
that being said, when I'm paddling, yeah, blood sugar typically does drop. So I try and aim to get my blood sugar up, you know, around 181 65, somewhere in there, before I get out in the water. And then I'm monitoring it pretty much during the whole panel, I have an Apple Watch. So I can see my blood sugar there. And you know, just keeping an eye on where things are, I have sugar if I need it. But at the same time, you know, I I'm focusing on the paddle, I put some electrolytes in my hydration pack so I can stay more hydrated, and keep everything kind of, you know, flowing a little better. But it's pretty much those two things, having water having my gu chomp there and having my phone connecting my Dexcom. So while I'm on the water, I can actually see what I'm doing. And if I need to eat, I figured out a system where I just open the little pocket before I even start a race. And if I have to eat during the race, it's just like a one second motion of grabbing a good job and eating it. And continuing to bottle.

Scott Benner 47:49
I'm dying to know, have you ever had to pull out your head and give yourself insulin while you're on the board.

Fiona Wylde 47:54
I have not had to do that during a race. But a lot of times after a race, I find that even if I was going down during after the race, I'll end up spiking, you know, whether it's excitement because I've won or just because I was going through a lot of the carbs that were in my system. And now I've stopped and I'm stationary and all those carbs are now sitting there and I start going back up. So I keep it with me. Because sometimes you finish your race and your you know, your bag or whatever is a little ways away. And so then yes, then I have given myself insulin on my board at the finish line to you know, prepare for that spike that I know is going to be coming after

Unknown Speaker 48:37
right you would

Scott Benner 48:38
I think you would really enjoy a couple of episodes that I've done with us CD named Jenny, who comes on the show a lot. And we've we did a lot about exercise and that kind of stuff. Cool taught you. I think I'll give it to you personally afterwards. And I think that'd be great. Thank you. I can't please. So okay, so. Okay, that's crazy. First of all, what you just said all of it is absolutely cool. But so, so the pen keeps track of when you've used your insulin, which is helpful. It also keeps track of insulin on board, right. So like, yeah, it's telling you, so I'm assuming you're just a person who didn't want an insulin pump. Is that right? You just weren't looking for an insulin pump.

Fiona Wylde 49:19
I like the fact that with the impact, I can always have insulin with me and I'd have to travel with extra cartridges. So for the ease of that I'm not a big fan of having multiple devices on me just because I typically have wetsuits or, you know, like hydration packs that are kind of squishing around my midsection and then up on my back and all that and for me, this is the system that I've come up with that works for me. You know, it doesn't mean that I you know, don't try an omni pod every now and again to try and Okay, Lena, let's see if this helps me study. Yeah, just to try the different things that are out there. There, but for right now, this is the system that I like that's working with me that I've figured out how to manage with my training and sports and all that. And for that, yeah.

Unknown Speaker 50:13
It works.

Scott Benner 50:14
It's excellent. No, it's amazing. So, obviously, everyone's their own person. And, and you're saying to yourself, look, this is a fear for me, if I lose my infusion set from a pump, I'm really afraid. Now all of a sudden, there's no slow acting insulin happening. And I don't I don't want that fear. And so what's the next best thing? And I think we're, a lot of people are just like, well, I'll just inject and I'll do this, that's fine. You actually found a piece of equipment that helps you even more, and yes, spectacular.

Fiona Wylde 50:43
That was the only thing that I was bummed about is it's like, okay, you know, if the qumulo quick, Ben's like, great, it's easy. But I don't have any of the data that I would have from a pump. And I mean, daily, it is so much about numbers and changing and trying to adjust to all these different things. And so when I found in pen that was like, Okay, well, this is a pen that I can just inject. It's simple. But it has all the data of a pump. I was like, Mind blown. Yeah,

this is a this is a win win. Like Where can I

Unknown Speaker 51:13
get this thing?

Scott Benner 51:14
Should you actually whip out like your in pen app and look at your data and make decisions about your next race and things like that? Oh, all the time.

Fiona Wylde 51:21
Yeah, it sits right next to my Dexcom app on my home screen. And I just kind of flip back and forth between the two. I'm like, Okay, this is how much insulin I have on board right now. This is where my blood sugar is, this is the activity I want to go do. Or maybe this is the homework that I have to do. You know, so I'm going to be sitting here for the next, you know, four hours, and I'm not going to be doing exercise. How do I plan all those things? Yeah. And that is where the in pen has really helped me take all of that into consideration,

Scott Benner 51:51
like so I'm trying to imagine you're getting ready to go on a, you know, a race, and your blood sugar is lower than you want it to be. You didn't then you check the pen app, it tells you how much insulin you have on board. Do you ever then just say, Well, I'm going to take a little bit of this these carbs right now because I think I'm gonna fall no matter what. Absolutely, yeah, this month? Yeah.

Fiona Wylde 52:10
Yeah, absolutely. Like if I am, you know, below, a certain number, or even if I am dropping, I'm saying I say I'm at like, you know, 165, but I'm dropping, and kind of quickly, you know, I'd love to start a race at 165. But if I'm dropping, then I'm not going to be at 165 for very long. So I will definitely eat a bit not, you know, if the reasons in an hour, I won't eat that much. If the race is in five minutes, and I'm paddling out to the start line in my deck spam shows an arrow starting to go down. That's when I start. Okay, it's time to lunch. It's time to have some food, because the worst thing is going into a race with arrows going down.

Scott Benner 52:52
Yeah, and I'm, so I'm assuming you can see, you look on the next con is, hey, look, I'm going down. But not only do I know I'm going down, but this pen is telling me I still have two units left in me, right? So I have to I have I have to feed that insulin right now before I get on this board, because I'm gonna have exactly I'm gonna have like the, the the impact from the paddling. And the impact from the insolence out there. And if you had a regular pen or needles, you would not know how much is left over, you would just think, oh, maybe this is the end of the Bolus or whatever. And you would write that same information. Yeah, I, you know, I always say to people that the difference between pumping and and injecting is just you know, with injecting you lose the ability to manipulate your basal insulin. And that's, that's sort of it. But the truth is, if you have an impact, that's not sort of it, you don't, there's a lot more you get within pen that you wouldn't get with a regular pen. If your insulin gets too warm in the pen, does the pen tell you?

Fiona Wylde 53:46
Yeah, it does, which for me is awesome, because I've have a lot of races in Asia, and you know, they're super hot and humid. And that's difficult. You know, it tells you if your pen is too warm or too cold.

Scott Benner 53:58
So for the people listening, I think we now need to know your dog's name. So sorry, don't be sad. Don't be Don't be sorry. I wouldn't want to know what her name is. Some people get her name is Sharky. Sharky, because I have to tell you, you have used the word twice. While we've been talking that I thought I wish I was cool enough to say cruzi but I'm not. And you've said it twice now and twice I've thought that is such an amazing word. And I don't want to spell it and I'm fascinated by your use of it. It's so perfect. I just like oh cruzi should be someone's nickname

Unknown Speaker 54:33
to get one shot he's not

Fiona Wylde 54:34
so much of a cruiser but she

Scott Benner 54:38
can I say something here and I only want 2% if this works out but I think you should start your own like wet gear line called crazy.

Unknown Speaker 54:45
Crazy.

Scott Benner 54:46
Crazy by wild. I'm telling you right now or wild cruzi or so there's something in there. I think it's it's fascinating, anyway and your dog sounds like a wolf by the way. Is that a giant animal

Fiona Wylde 55:00
She's actually quite a medium sized Husky mix. But see weren't too far off with that one was really about 40 pounds. I thought

Scott Benner 55:08
she was chasing a bear away from your log cabin or something like that what it felt like?

Fiona Wylde 55:12
Yeah, I mean, I'm in Oregon. I'm not that far out.

Scott Benner 55:16
Right now people on the East Coast are like, how come he makes fun of places like Maine, but he hasn't made fun of Oregon yet? And the truth is, I don't know. Because I've thought of it a couple of times, but I just haven't done it. So I there's something about Oregon. No, no, I like I like, Oregon seems like a place I would want to be. So

Unknown Speaker 55:34
it's definitely a place I like to be. So tell

Scott Benner 55:36
me a little bit about using in pen while you're traveling like airplanes, hotels, that kind of stuff.

Fiona Wylde 55:42
The nice thing is, you know, traveling with time zones, and all that stuff is really difficult with you know, diabetes and insulin management because, you know, especially if you are going to be doing, you know, you're giving yourself long acting insulin in addition to, you know, your short term insulin for meals. That gets a little bit tricky. Okay, being able to keep track. I mean, my favorite thing about the infant is probably its most simplest function of just being able to see how much insulin is on board and being able to have a device that helps me calculate. Sorry, don't be

Scott Benner 56:17
sorry. Don't be sorry, people miss people actually miss my dog on the podcast, I moved to a different part of the house to set up a more permanent place to do the podcast from and because of that our dog bazel does not snort and, and snore in the background anymore. And I get notes sometimes, like, I miss bass on I was like, Yeah, I don't because all I would do is sit there listening and think God the dog so loud, it would make me nervous the whole I'd like to understand what the circle of life is there between the pen and the Dexcom and the app. Like so. If you want to take care of him first Sharky first and don't feel don't feel any pressure.

Fiona Wylde 56:59
We had the doorbell go off. So it's an exciting morning over here. How can

Scott Benner 57:03
there be visitors so you don't live in the middle of like,

Unknown Speaker 57:07
like, I don't live in the middle of the woods. I actually I

Fiona Wylde 57:09
have a bunch of neighbors that live all around me

Scott Benner 57:11
people. Alright, so you're like the doorbell? I'm like, Oh my god, the doorbell that was probably Sasquatch. She's gonna be dead in a sec.

Fiona Wylde 57:19
Yeah, and if it's okay, if you don't mind giving me one minute, I can just put you on mute and come right

Unknown Speaker 57:23
back. I'll do a chat.

Scott Benner 57:26
Hello. Hey, she's back. How are you?

Fiona Wylde 57:29
We're back. Sorry about the interruption.

Scott Benner 57:33
Please, please don't be sorry, you sound terrific. explained to me how in Penn integrates with the Dexcom CGM and the app on your phone.

Unknown Speaker 57:41
The two apps are

Fiona Wylde 57:42
separated, they're next to each other on my phone.

But the companion medical app that shows me all of my in pen data, that app has also my dexcom data on it. So it helps. Like basically when I give myself insulin that will come into, you know, show up as a little.on my screen. And on top of that, it'll also show me my Dexcom data as well. So I now I can see like, okay, I just gave myself three units at 130. And then as the information goes across the screen that.of my Dexcom Okay, where my you know, current blood sugar was when I gave myself that insulin also moves with it. So then you can have an idea of like, Okay, how much insulin you gave yourself? At what time? And, you know, okay, did I get myself the right amount of insulin? Or do I give myself the wrong amount of insulin?

Scott Benner 58:38
Does? Does the pen have a dose calculator?

Unknown Speaker 58:42
Yes. I use it all. Yeah,

Scott Benner 58:45
so it does that. So it so you're, you're in pen app has information from your Dexcom on it. So you open up your pen app, it knows what your blood sugar is, because of your Dexcom do you then just tell it This is how many carbs I'm thinking of having and it tells you it's suggested amount of insulin?

Fiona Wylde 59:02
Yeah, so I've set prerequisites of Okay, you know, this is my carb ratio, and this is what I'm planning on doing. And it'll Yeah, you pretty much put in, you know, how many carbs that you want to do and, or want to eat? And then you give yourself, okay, you know, it's suggesting this amount of insulin, you're like, Alright, I think that's about right. Or, you know, maybe I'm gonna have a little bit more food than that. So I'm gonna give myself a little bit more. Um, but it's nice because you can, you know, you can think of, Okay, what, what do I want to eat? Um, you know, how many carbs are in it roughly. And then it's nice, because I would normally just be like, okay, that for me, that's this amount of units, whereas we using that it definitely gives you more precise,

you know, just gives you a more precise number, like, no,

if you're not, you actually need more insulin than that you're going to go high. And so that's been a that helps me kind of alleviate a lot more of the like, big swings of up and down.

Scott Benner 59:56
That's excellent. Um, but yeah, that's one of the Major things that's missing when you're injecting, right? Yeah, that whole piece of it plus now. So now the pen app knows how much insulin is on board. So in the similar situation in the same situation, except, say you've had a, I don't know, say you had a snack at 11 o'clock and you gave yourself some insulin, now, it's just an hour and a half later, and you're going to have a meal. When you put in your, you know, I'm going to eat 40 carbs, it takes into account the insulin still left from the snack and it gives it gives you a different dose. If that insulin still active, yeah. Oh, my gosh, and and how valuable Do you find that information?

Fiona Wylde 1:00:37
Well, for me, it's huge. Because, you know, a lot of times I, you know, it's easy to just look at a meal and be like, okay, that's, I know how many carbs are in here. And that's how much insulin I'm gonna eat. But it's harder when it's like, okay, I already gave myself some insulin for food a little while ago. And I don't necessarily know how much you know, insulin is left or how much has been absorbed. And so then you end up stacking insulin and for me, well, for anybody really, I think stacking insulin is one of the things you want to try and avoid the most.

Scott Benner 1:01:09
Yeah. Now, you do not want to have more insulin than you need in your body, that's for sure. No. Have you had any experiences with the M pen app telling you, Hey, your insolence getting too hot or too cold?

Fiona Wylde 1:01:20
I haven't had it where it's too cold. A lot of the times I'm traveling to warmer places, which is kind of nice. But I definitely have it where it's been like, Hey, you have

Unknown Speaker 1:01:28
an alert, you

Fiona Wylde 1:01:30
definitely need to, you know, cool your insulin down, or pretty much like, Hey, your insulin is too hot, you know, replace it.

Scott Benner 1:01:36
That's, that's excellent. And that's probably incredibly handy for people who are traveling or I mean, your sport thing is so like, different than most people's. But in a similar vein, people go to the beach all the time with their insulin. Yeah. And so if you think, you know, maybe I guess it's just so simple that you're like, oh, I'll put it here in this bag, and it'll be okay. And then it ends up not being you would never know that. And this thing just sends an alert to your phone is like, hey, the pens too warm, and you move it somewhere cooler.

Fiona Wylde 1:02:03
Yeah, it's cool. And you know, the, the great thing about that, too, is it'll, it'll give you reminders of like, hey, you've used your pen for 28 days, it's time to replace it. You know, even if you still have insulin remaining. Stuff like that, you know, I used to write and Sharpies on my pens like, Okay, I need to, you know,

Unknown Speaker 1:02:19
go ahead. And,

Fiona Wylde 1:02:21
yeah, I can only use it, you know, until the 21st, or whatever, and then I'd have to toss it out. But now it was all, you know, reminded, I know how Sharpie marks all over my pens.

Scott Benner 1:02:29
How does that work? When you pop in a new cartridge? Does it reset on its own? Or do you have to tell it like I put a new cartridge? Oh,

Fiona Wylde 1:02:36
no, when you put a new cartridge into it pretty much knows that you put new cartridge you have to, you have to say that you're putting a new cartridge in just like kind of how you would with a Dexcom where you're like, Okay, I'm you know, bearing a new Dexcom. You don't have to take a picture of it or anything like that, like you would with the G six. But you do have to just, you know, put a new cartridge in. And you have to prime it a couple times. Just so you know that. Okay, your meal isn't blocked or anything like that. Yeah. And then it starts recording, and you're good to go.

Scott Benner 1:03:06
That's amazing. What do you use the information? You said earlier in the interview that you use the information to make decisions about like what to do next and stuff like that from the internet. But does the app also lend itself to you talking to your endocrinologist with the information? Oh

Unknown Speaker 1:03:22
my goodness,

Fiona Wylde 1:03:23
yes, that is the best part actually. Because it prints out massive charts. Like I can print out like four page charts from months and months and months of data of using the input pretty much as long as you're using the input and you can print out a chart that shows your Okay, average time and range. The average insulin that you're giving yourself the most amount of insulin you're giving yourself what to expect in terms of like targets and all that stuff. And it has helped my endocrinologist night a lot trying to figure out okay, hey, look, you look you have this pattern here. Let's try and figure out how to solve this pattern that helps me alleviate some of the highs and lows.

Scott Benner 1:04:07
So you and the doctor find the the charts and the graphs that the pen app gives you like relatable and easy to understand. It's not.

Fiona Wylde 1:04:15
Yeah, they're all color coordinated. And all that which is really nice.

Scott Benner 1:04:19
I like pretty colors. Colors are cruzi

Unknown Speaker 1:04:24
definitely crazy.

Scott Benner 1:04:26
Is there anything about the pen that I haven't asked you that you really think, wow, this is what people should know about it.

Fiona Wylde 1:04:33
They also give you your long acting reminders. So I take lantis. So it'll give me a reminder of like, Hey, you need to take your lantis and then you can record that in the pen or sorry, in the app as well. So it says okay, I just gave myself X amount of units of lantis. Like it's all recorded in there. And that's good too, because that kind of goes back to my thing of Oh, oops, yeah, I forgot to, you know, give myself this or give myself that

Unknown Speaker 1:04:58
and it basically Because with

Fiona Wylde 1:05:00
pens, it is kind of easy to forget. Or it's easy to just like give yourself insulin and then walk away from it is you don't have something attached to your body for the constant reminder to, in a way, like, I definitely feel a bit more free, which is really nice. But it's easier to skip some things too. And that's where the in pen, make sure that you don't skip steps that, you know, maybe are easy to forget, but helps you plan for the steps that you didn't forget. And then it helps you plan for the future as well, which is good. Hey, everybody

Scott Benner 1:05:29
can use somebody on their side to go Hey, don't forget to take your insulin right now. Or, you know, this is happening like it's diabetes has a lot to remember. And I think

Unknown Speaker 1:05:39
so many moving parts. Yeah.

Scott Benner 1:05:40
Right. And so if there's an app, that's, you know, listen, it's it's really kind of fascinating when you stop and think about like, you're young. So you think the whole world works like this. But for most of us, an insulin pen that attaches to my an app on my cell phone that's talking to my continuous glucose monitor that's reading the interstitial fluid and telling me what my blood sugar is or how fast it's going. And then tells me Hey, you know, I know you probably think that this lunch is four units, but you forgot that you gave yourself insulin an hour and a half ago, so we're just gonna do three and a half instead. That's a lot of cool. All in one place. Yeah, it was more

Fiona Wylde 1:06:13
than cruzi. Yeah, no, that's just like, super cool. Exactly.

Scott Benner 1:06:17
Yeah, it's really it's mind blowing. And I'll tell you right now, for people who've had diabetes for 10 years. They're like, Wow, that's really great. People have had it for 20 years are just blown away by this idea that this is this is an entirely different world for them. And you know, it's just it's very cool that you came on talked about it, I really appreciate it. Well, Fiona is just a another in a long line of people living with Type One Diabetes doing what seems like amazing things to me. I'm sure those of you who have ever served or stood up on a paddleboard or like, Scott, it's not that amazing. But first of all, she's competing at a very high level at this, you're just doing it for fun on vacation. And B, I don't want to do that. So it all seems very scary to me when people are like, I got up on a big wave and came flying down to the earth. Hmm, no, I don't want that. But I love that she likes it. And I love how well she does with her diabetes. While she's competing. I hope you enjoyed listening to Fiona. And I hope you enjoyed these last number of episodes, or I think the last three months on Fridays that have been sponsored by companion medical, I want to thank them very much for their support of the Juicebox Podcast and say that I think there'll be back in 2020. You can check Fiona out at Fiona wild calm. She's also got a really great Instagram account, because she's doing like cool stuff on it. So let me see if I can find it for you real quick. It's just Fiona underscore wild. And she's always standing on something that looks like it shouldn't really float or laying on something that looks like it shouldn't float or standing and laying where she's got it. Anyway, she's just always balancing on something in the water, which is really cool, you should check her out. And if you're thinking of taking a pump break, or you're using MDI right now, you really need to take a moment to check out the pen. Not only does it do amazing things and give you a lot of the functionality that a pump can give you. But the cost of it will surprise you. So check out the in pen go to companion medical.com right now. There are links in your show notes and at Juicebox podcast.com. If you can't remember companion medical.com but I feel like you can

Unknown Speaker 1:08:27
bet Juicebox Podcast is super crazy. Thanks for having me on the show today.

Scott Benner 1:08:32
The first person to leave a review of the podcast that indicates that the show is supercruise he gets a shout out on the show. Just make the review somewhere send me a link to it so I can see it. I just want to see it in print somewhere. Make sure you spell cruzi correctly.


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#288 Defining Diabetes: Ketones

Scott Benner

Defining Diabetes: Ketones

Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care. This episode is a companion to episode 287.

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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
Hey everybody, welcome to Episode 288 of the Juicebox Podcast. Today's show is a defining diabetes episode that is a companion piece to Episode 287. So Episode 287 is a diabetes pro tip with Jenny Smith, about illness injury and surgery. This defining diabetes episode is all about ketones, they go together. So if you're having sickness and illness, you might have ketones. And that would make all this important to understand. Today's episode of the podcast is sponsored by the merch store at Juicebox podcast.com. That's right. Juicebox Podcast merchandise is sponsoring this episode, which is to say that I am now why am I taking the time to tell you about this large price drops on all of your favorite stuff. The merchandise supplier I'm using has dropped their prices, which allowed me to pass that savings on to you some of the drops in cost are significant. So go take a look. Juicebox podcast.com, you click on the link in the like, so what do you do? Maybe I don't even know Juicebox podcast.com then there's a little thing in the top corner top left corner, it's like three little lines. That's a menu. You guys know that. And then it gives you a little drop down emerges one of the things you can choose. And there you'll see some reductions. 3421 of them's down like $6, maybe me say, well, there's some shirts that went from 2490 to $16. So check it out. All of the money that I make on this stuff goes back into the podcast, I have recently upgraded audio equipment, and your new computer. And I have to add a microphone, because I think Arden is going to come on the show in 2020. So I'm gonna need another mic. Anyway, all that stuff that you guys buy goes towards helping me with that. I really appreciate it Juicebox podcast.com. And now defining diabetes with Jenny Smith, you know, Jenny from integrated diabetes, right? If you want to hire Jenny, go to integrated diabetes.com Check her out, send her an email, her email addresses also right there in the links in your show notes. And you can find it also at Juicebox podcast.com. Alright, ready, defining diabetes Episode 288, the companion piece to 287 with Jenny Smith.

This one's gonna be really appropriate because some of the stuff we've done recently. I'd like to define ketones. Hmm. And then explain to people when they happen and why they happen and how they change your insulin needs. So in the reason that this throws me for a bit of a loop, is because there's the keto diet that works off of ketones, but those aren't that no not for ketones. There's a keto diet that works off of ketosis, and there's nutritional ketosis, okay. And there's ketones that you get from not having enough insulin because you've been put into ketosis for not having enough insulin, but Betty being put into ketosis for not having enough insulin is not the same as being put into ketosis because of your nutrition. And I don't understand why that sounds like something. My wife said to me that I didn't understand. And I just nodded along with because I didn't want to get yelled at. Right like that. Totally. When, when, like, I was talking to Vicki on the podcast the other day, and about her ketone diet and how or her see it throws note about her keto diet and how she bonuses for it. And when she explained that part of it. I am not gonna lie to you. I nodded along like Vicki and I were married. How's it go? I get that I completely understand. Yeah, sure. That makes a lot of sense. Thank you. I

Jennifer Smith, CDE 3:41
looked at your like, a Ha ha ha.

Scott Benner 3:44
I asked the question, I was gonna ask the wrong question. And then I was gonna look like an idiot. And I didn't want to do that. So I thought I will just talk to Jenny about this. So I guess let's break it down into ideas. First, type one diabetes, I don't have enough insulin is one of the reasons I could produce ketones. Is that right?

Jennifer Smith, CDE 4:04
Right. And so in name wise, you're right. It's kind of like ketosis versus ketoacidosis. Two different things. Right, keyed ketoacidosis essentially reverse to decay. It could be a potential complication of you know, having type one diabetes, because we are at a complete insulin deficit, right. That's the reason we either pump it, inject it, inhale it, whatever you're going to do, you got to have your insulin right. And essentially, if you are in DK a, it essentially makes your blood too acidic. And that changes the normal function of many of organs in your body like your kidneys and whatnot. I mean, you have to get treatment for DK you do. Hydration is a huge part of it. And DK A is a result of a A significant deficit of insulin. It can happen for lots of reasons, either, you know, your pump site has failed and you didn't realize it and you're sleeping overnight, and you don't have a CGM, and you didn't get an alert for it or could be because of illness, and high blood sugars and not eating. And sometimes starvation, ketosis can lead in illness, to DK A, B, because of the way that the body isn't getting enough food and the potential for higher blood sugars and not correcting them and whatnot. So ketoacidosis is not what you want, right

Unknown Speaker 5:34
at all.

Jennifer Smith, CDE 5:36
And it can happen very quickly, I mean, in less than 24 hours, you know, you can in a body that doesn't make any insulin, you can be in decay very quickly. So, ketosis is difference, it's essentially the presence of ketones, which aren't harmful. And I will say that, again, ketones are not harmful. In fact, most people I mean, who who has diabetes has regularly tested their ketone level, unless they're ill or have a high blood sugar. That's when you're told to test your ketones, right? Right. ketones, however, are very common. If you test first thing in the morning, you are in a fasting state. Okay. And so in the morning, if you tested ketones, even if you're not on a ketogenic diet, or a low, low carb diet, many people wake up with ketones low level very low level in the morning, because they're in a fasting state. And in a fasting state, your body is essentially relying on fat stores to keep you going, as overnight, you're not eating in any fasting state, you're not technically eating, but your body still needs to get energy or derive energy from something. Right. So it resorts to fats.

Scott Benner 7:04
So basically, and that is God I'm sorry. that produces Yeah, go ahead. I was. Basically, when you wake up in the morning, had you gone to say you went to bed at 10pm, and you woke up at eight? For the last 678 10 hours? You've been at the beginning of your low carb diet? Because you haven't you? That's right, right, you have you haven't taken a carb. So the body begins to do what it does in a low carb situation.

Jennifer Smith, CDE 7:30
Yes, and your body is essentially tapping into your stored fat to burn something for energy in a place where there is no food coming in. Unless you're the person who sleep walks to the fridge and eats overnight, I can guarantee you're not going to be in, you know, you're not going to have low level ketones, fasting ketones in the morning. But in terms of people who do choose the ketogenic diet, essentially, you are teaching your body to no longer rely on carbohydrates for energy, but you're not doing it in a deficit of insulin. People with diabetes who are following a ketogenic diet, and are eating very low carb, and by defining low carb on a ketogenic diet, it's typically less than 50 grams of carbs a day, most are following less than that usually more around like 30 grams or less a day to maintain nutritional ketosis. And so what does the body revert to? It burns fat. And so those those diets on a kind of a flip side of what we the ABA typically teaches, which I will say it here is has tended in the past to be very carb heavy. Um, that's where I'll leave that. But the flip is the is true for a ketogenic diet, they essentially consume about 70 to 80% of their nutrition calories from fat, right? And very little from carbohydrates, somewhere between, you know, maybe five to 10%. And then protein is also very lean. In a ketogenic diet. It's not a high protein, high fat, it's a high fat, mild to moderate protein and very low carb intake. Do you in that diet? Vicki told me that you get the glucose because your body turns the protein into glucose, if you ever heard that before. Yeah, yes, actually. So with that's why you have to be kind of really conscious of what you're taking in. If you're aiming for a true ketogenic diet. If you're truly maintaining ketosis, you can't have a lot of protein, you have to look at how much is coming in because you're so low carb that in a low carb environment, your body will resort to protein conversion.

Scott Benner 9:59
Okay, today glucose,

Jennifer Smith, CDE 10:01
okay, so if you're taking in too much protein in such a low carb intake your bodies instead of taking in the fat and using it for fuel and being in true ketosis, your body is going to say, hey, there's some protein here in excess of what I need. Let's just use that for glucose. So it's it's a fine line of managing, which is why, you know, when somebody comes to me and wants to talk about ketogenic diet, I, you know, there's nothing specific about any diet that I'm like, nope, don't do that. Don't try it at all, whatever. I'm happy and willing to work with whatever kind of plan you want to work on. But you have to understand the difference between all of the things that are out there, you have to do your homework, and it takes work. It takes upfront work of really understanding, healthy and safe, nutritional ketosis.

Scott Benner 10:53
I put the I put Vicki's episode talking about bolusing for her keto, for keto diet and your my episode about fat and protein, I put them up on the same day, because in my mind, they looked at two different things from the same angle and different with different theories, like but they they all fit together to me correct. I thought you really needed to hear both of them to understand. So okay, so two things I want to go back to the first thing is, if my blood sugar is very low, and I feel like you said this before, but I want to make sure I'm clear, but I'm sick. I could still end up in ketosis because I'm likely not eating. And am I getting? Am I getting a mixture then of ketoacidosis?

Jennifer Smith, CDE 11:34
If you're? Yeah, yeah, you're right. If you're, it's a it's a fine line. And it's one that we talk about a lot with people now, on low carb diets and talk we in talking about illness and illness management. If you're already in ketosis, and you are then not really eating and blood sugars aren't necessarily going to be excessively high unless there may be an infection. We know that infections are such a stress on the body that you will likely have higher blood sugars, but high that's typically defined with the worry for DK a is greater than 240. And that's why many meters and pumps and whatever you put in a blood sugar is more than 240. It says check for ketones, you know, right? Right, I probably remember that from you know, PDM, it tells you right away check for ketones with the blood sugar. But if you are ill, and you're running higher blood sugars than normal, let's say you are typically running at 90 because you're on a new, you know, ketosis type of diet. Now your blood sugars are running at 141 40 might not be a bad blood sugar. But it's and I hate the word bad. But you know, for somebody who 90 is normal 140 is like oh my gosh, I'm you know, at 140. And quite honestly an illness, you may end up getting yourself into the potential for trouble with ketoacidosis, even at a number that doesn't look, quote unquote high. So again, what goes into that is the management of hydration, the management of the amounts of insulin that you need, if you're typically running at a 90 blood sugar, but your blood sugar's now 140 or 150 and you're not eating and you have normal ketones floating around in your body, those ketones could get higher than they should be in nutritional ketosis leading you into decay. So that's, that's again, we're defining like ketosis versus ketoacidosis. Those ketone levels are very, very different in ketoacidosis. If you're doing a blood glucose or a glucose, blood based ketone test, not a urine but a blood based ketone test with a monitor, you will have very high ketone levels, I mean, four or five, six, on the scale of measurement. in ketosis, typically, ketosis is, depending on what you need, could be anywhere between a value of like 1.5 to three ish for normal ketone levels in nutritional ketosis, and people who are really trying to follow a ketogenic diet. They typically follow their ketones if they're trying to maintain that they're doing a good job about maintaining and once once they have a pretty standard to what they're eating and taking in and whatnot through the day. They may do it less often, unless something changes again for them. But for the most part, they they really try to follow their ketone levels to make sure that they're in that safe, like nutritional ketosis range.

Scott Benner 14:42
Okay. Jenny was probably stunned like watching me think, but she I don't think she does very often. Usually, I'm just waiting, listening.

Jennifer Smith, CDE 14:51
You were looking at the ceiling at a viewer

or something, you're like what's coming

Scott Benner 14:57
to absorb what you're saying. I and I have one little Last question wrapped around this. And I am wondering if I'm not seeing what I think I'm saying. So I have one real clear memory of Arden having the flu. Yeah. And she, her blood sugar was low. This is prior to CGM, her blood sugar was always around like 75 or 80. While she had the flu, sometimes she'd be low, she was sucking on candy for days ever, I'd be like, Here, put this in your mouth, you know, and she'd sock on it, I'd reach it. I don't give it back. You know, like I was literally like, just trying to get sugar and, but then all of a sudden she's got ketones. And they're like to on the blood glucose meter that we have, or the blood ketone meter that we have. And I call the hotline to the, you know, the hospital, and they're like, you have the Bolus for those ketones. And I said, What do you mean, they said, but she's two units, one unit for each number, like she was one if she was one on the ketone meter, we'd have you given one unit if she was to have to. So her blood sugar's by five. She's like six years old, she weighs nothing. And they want me to give her two units of insulin. And so I was just like, You're sure. And they're like, yeah, I had the flu. So I was probably like, Yeah, all right. Well, I mean, I guess if this is how we go out, like, let's try this, you know, and I like, and I gave her, they what they're telling me to do, I'll blame this lady at the funeral is what I was thinking, right, like, so I gave her the two units, and it worked. And she didn't get low. And till To this day, I can't explain that. Like, I don't understand that well enough to explain that to anybody. I know what happened, I watched it happen. So

Jennifer Smith, CDE 16:37
right, and what it deals with, like on a physiologic level, I to explain it, I guess in a simplified way, because I don't I don't know all of the physiology completely behind it. But in a setting of ketones from like a DK, or you know, ketoacidosis kind of setting, the body requires more insulin to overcome the ketone level in the body. And so even at what what was looking like a normal level of glucose for her, in fact, on the lower end right at and you're thinking, Oh, my gosh, she's not eating anything, and I'm going to give her two units of insulin, what you needed the insulin for was clearing of the ketones. And along with that comes hydration as well. And I would expect they probably were encouraging you to kind of be a force as much fluid as possible, right, get it in. But, I mean, there are some very defined ketone management strategies for how much extra insulin you should be given based on where your glucose is, what your ketone level is. It has to do with how much insulin do you currently use from a base basal amount, and how much extra should you give to a correction for blood sugar to overcome the ketones that are also there along with that blood sugar. So typically, let's say blood sugar of 200, you would use one unit to bring you down to your target of 100. With ketones, there's a there's a percentage extra that you would need to incorporate to say, okay, 200, to also clear, the ketones along with bringing this blood sugar down, you're going to need a certain amount extra to that one unit you would normally take to actually start bringing it down and get rid of the ketones. So

Scott Benner 18:34
when they tell you your bolusing, for the ketones, there's really a much bigger physiological thing going on. It's just sort of how we are. Right? Correct. Okay. So is this attached to the concept of if my blood sugars been say, I'm not sick? And you know, it's a regular day, but my budget has been 300 for a few hours. And where you would hear me say, high blood sugars require more insulin? This is why is it possible? Is this part of it? Do you think or, like what, you know, when your blood sugar is high, it's stuck, and you need more? Do you think you have ketones at that moment? You don't realize? Or no,

Jennifer Smith, CDE 19:13
because I don't, you know, I don't think most people really are again, testing. If they've got a one off high blood sugar for eating the whole cake versus only eating one slice, you know, I mean, in that setting, the high blood sugar that requires a little bit more insulin, I think that there are more variables there potentially, again, a miscalculation to carbs, right. So of course, you're probably going to need some extra insulin, not just to correct the blood sugar but to correct for food that you didn't account for before in the original Bolus. Also, I mean, and I kind of call them sort of sticky blood sugars right sticky and the fact that you just you have to take more insulin and thus, the strategy of sometimes even using a temporary bazel increase around a house Blood Sugar along with a bolus to get it to start moving more effectively? You know, that's a really good question. If ketones are maybe potentially in the picture there already, or, you know, how quickly do ketones really start to kind of develop, I mean, they're more so in the picture of like a true ultimate insulin deficit, right? I have a feeling that it has more to do with kind of what we actually just talked about a little earlier is like that resistance.

Scott Benner 20:29
I was just thinking,

Jennifer Smith, CDE 20:32
is that like, a resistance is there, you know, some, um, but for most people, I would say people recognize that above about a 250, blood sugar, it takes a bit more insulin, for whatever reason to bring the blood sugar down.

Scott Benner 20:50
Yeah. So with all these, you, if your brain can wrap around all this, bless you, I think that's great. And if you can think of all this stuff in the moment and make better decisions within something, that's great. But just in case, you're like me, Scott has very kindly boiled this all down to more insulin. So just I know, it's, that's just the day when I realized there were all of these different factors happening. And I couldn't figure out what they all were, I just thought I don't I just resolved myself to the fact that this requires more insulin. And I'll use a more and that'll work. And it does. So. All right, cool. Wow, that one I don't even know I don't even think I can call that a defining divide. That was like a mini like, pro tip episode on like a bunch of words that are all sound the same. That By the way, again, when people use a develop language, don't make one thing ketone, the other thing ketosis, and then the diet keto, you confuse people, I go right back to the looping thing. If I want my my, my sensitivity factor to be more powerful, the number should get larger, not smaller, whoever said that way, wasn't thinking about me in my regular life. And I feel, I felt that we're thinking

Jennifer Smith, CDE 22:00
about math, we're not thinking about the regular layman brain. It's great. I got a lot

Scott Benner 22:05
of engineers telling me how to think about my insulin. So I just I'm just telling you that you don't say keto ketosis and ketoacidosis expect people to keep that all straight. But anyway, try. Try. That's kind of the same

Jennifer Smith, CDE 22:17
reason that that Dexcom uses the GI instead of a one C in their prediktor. In their clarity reports, they had to get rid of that being an A one c because it technically a one C is specific to the hemoglobin and whatnot from a test in the bloodstream and whatnot. So they, I would assume legally, they couldn't use a one c this and they had to figure out a new fancy word for it. So glucose management indicator was the next best like term, whatever,

Scott Benner 22:49
doesn't even realize she just teased another episode for you. So we're not talking about that. Oh, but that is definitely one of the things we're going to talk about eventually. Thank you Jenny Smith for being here with me today and talking about ketones Don't forget go to integrated diabetes comm To find out more about Jenny, and to hire her to help you with your blood sugar's and etc. Thank you also to me for sponsoring the episode, which is to say I'm thanking you for considering buying some merchandise Juicebox podcast.com, upper left corner, click on the menu go to merge, you're going to see a huge drop in costs for almost every item that's available. proceeds go to me, I pay taxes on those proceeds. And whatever's left, I'm going to buy a computer with a microphone. So this episode came out at the beginning of the week when it normally would come out on Friday, but there will still be an episode on Friday, don't you worry. And look where we're at December 2019 388 episodes into this podcast. So let me say you're going to get one more on Friday. And then I might start going to a Monday Thursday schedule instead of a Tuesday, Friday schedule. I'm thinking about that. So anyway, there's gonna be one on Friday the 13th. And you'll get the 16th and 19th. And I don't let up just because of the holiday, you're gonna get one of the 23rd. And then the day after Christmas, to for like five more. And then on the 36 there's six more left in this year. I could have just said there are six more episodes left in December. But you know, what am I gonna do? You don't want a shirt and you still want to give me a gift. You can donate to the podcast. Again, I'm not a charity, so I'll pay taxes on it and whatever is left computer payment, or if you can't afford any of that, but you still really want to help help my soul by leaving an amazing review. Like go to Apple podcasts, you know, and your podcast player whichever one you're using, wherever you can, like leave a review. And if the show has been truly helpful to you, please describe to others how it has been, because that might make them think maybe that could be like that for me. And then maybe they would come check out the show. And of course you can always Just share the show with a friend or an acquaintance, somebody who you think may enjoy it. Last thing, if you're a thoughtful person about your management, and you try to stay away from the drama about type one diabetes, but you're looking for community, may I suggest the private Facebook group for the podcast, the juice box discussion group, you have to answer like a couple quick questions like, you know, what my connection to diabetes is, basically to make sure you're not like a robot. And then once you're in, you'll have a community of now 1800 people who are answering questions to each other. It's a very collaborative and supportive group. If you're into something like that, you know, no drama, no head games. Check it out. All right, there's gonna be links to all of this in your show notes, and then the episode guide at Juicebox podcast.com. Today, links for Jenny Smith links for the merge links for the private Facebook group. You know, I said that was the last thing but but one more last thing. I am incredibly just looking proud to say that this podcast ran at six new episodes in 2019 86 new episodes. And I believe that in 2020, that number will be more like 100. This really cool, because obviously, these episodes wouldn't exist. If the interest wasn't there. I wouldn't be here like pumping out all these episodes. If no one was listening, I'd be like, oh, okay, I guess nobody cares. And then I might stop. But it's clear that you guys care. The downloads are insane. In the time, it took me to tell you about the 90 some episodes that ran when I say 86 episodes that ran in 20 1940 people downloaded the podcast. Again, that time frame. It's incredibly cool. So I appreciate your support. Appreciate listening to old episodes telling other people about the podcast really is absolutely our warming. All this makes me incredibly excited to start season six right away in January. When Let's take a look. Pulling up my calendar. Looks like you'll get one in January right around the second right after New Year's for the first time. I even think I know what episode I'm going to give you that. I think I have something uplifting for the new year. We'll start off strong.

Alright guys, thank you so much for listening to the Juicebox Podcast for sharing it for buying the merch for continuing to support the Oji sponsors Dexcom and Omni pod and dancing for diabetes. And of course, the love I expect you're going to give next year to new sponsors the Contour Next One blood sugar meter that Arden uses and G Volk g vocus. glucagon pre mixed prefilled ready to go more about that next year. So next year, we're going to talk more about the Contour Next One from a sensia G vocht. glucagon, of course, always on the pod dex calm and dancing for diabetes. And who knows what else. But for now, those are the sponsors that keep the podcast floating. You are the oars that propel it along. Imagine that. You're the oars. We're cruising through the clear water. Just once in a while hearing the oars just break the surface. We're moving along gracefully. Hmm. gracefully. Stiff wind in our back. Helping people get their blood sugar's where they want. Hmm. As they were still you get it right. And then variabilities coming down, people's stress is melting away. As the show becomes more popular. it affords me more opportunities to go visit people in real life give these great talks. We're winning understand, we're way ahead. All the other boats are behind us and they're just like splashing through their oars are just like slapping the water because they don't think about us. Barely breaking the water. cruising along. That's the Juicebox Podcast. Alright, this is it. We're done now.

If you're interested in see me live, my event schedule is at the Juicebox Podcast bold with insulin Facebook page, so it's bold with insulin on Facebook. Go to the event link. There's also artist a.com scroll to the bottom and click on events coming up Oklahoma City that's coming soon. January 11. Dallas February 16. That's it the greater Dallas type one nation event, Georgia type one nation event February 29. I'm going to be doing an evening in Appleton, Wisconsin or right around that. Yeah, Appleton, Wisconsin. I'm pretty sure it's exactly where it's at March 26. It's a Thursday night, I think from like five to 8pm. Just Scott talking, not one of those type one diabetes events, sort of a Juicebox Podcast live event, just for you, Wisconsin, that on May 30. I'll be down in Orlando, Florida for the touch by type one event from dancing for diabetes. And on August 22, Richmond, Virginia type one nation event. And I think I think we're still in talks in Indianapolis. somewhere else, I'm not sure but if I do many more of these, my wife's going to shoot me. So I think this might be it for the short term. But I'm always interested in hearing about 2020 at the end of the year 2021. If you know somewhere you'd like me to be, reach out. I'd like to be there.

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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#286 Defining Diabetes: Stop The Arrows

Scott Benner

Defining Diabetes: Stop The Arrows

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

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

Scott Benner 0:02
This episode of defining diabetes on the Juicebox Podcast is sponsored by companion medical makers of the impact. You can find out more about the in pen, ai companion medical.com. On today's show, Jenny Smith and I are going to define a term from your diabetes life. This one's very specific to the podcast, stop the arrows. What does that mean? This is going to be one of those where I'm like, Jenny, hey, I made this up. What do you think of me is

injured. Jenny's gonna tell you. That's how this works. I say Jenny define this. And he goes, Oh, that means this. And then I say something. I'm like, haha, I think this bah, bah, bah. And then she goes, Oh, I agree with you. The baby, sometimes she'll be like, I don't agree with you. And then she'll be more clarifying. And then it's over. Defining diabetes. There it is. That's the magic. 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 for becoming bold with insulin. Alright, you're ready for Jenny? She's particularly delightful in this episode.

Why don't we define a couple of more like podcast tenants. And so this is where this is where I asked Jenny to define something that I've made up. And that way she can. Either always fun, right, right. Yeah. Right. Cuz, you know, I had, you know, we did the we did defining, you know, over Bolus, which again, is just a word I made up. And and we'll do some other ones. So we've done a couple. And some of them are bigger ideas are not just words, right? So if I told you that I consider stop the arrows to be a real diabetes term. It is it is to me and I think enough people do it now that that I'm buying into my own my own hype, a little bit on that. If I said to you, can you define stop?

Jennifer Smith, CDE 2:19
You are because on our assessment, on our assessment, many people actually say, I found you from the juice box. And I want to be able to stop the arrows. And many of them actually have it like in quotes, as if they're like, it's Scott's term. So I have to like quote him on. Oh, yes.

Scott Benner 2:38
Let me just say I appreciate the attribution. I really do. I get ripped off a lot in this space, Jenny. But when people say they heard it from me, it makes me feel better. So that I like that. So stop the arrows. What does that mean, to you?

Jennifer Smith, CDE 2:53
To me, essentially, you are both up arrows and down arrows, and very significantly straight up arrows and whatnot, it's essentially just pay, it's reacting to the arrow and saying, I need to stop this and plateau it I want to get it to even out. And that might be with some type of insulin adjustment, it might be with a little bit of insulin adjustment and some food of some type. But that stopped the arrows pay attention to, I think stopping the arrows also has to do with alerts and alarms, too. So I think that needs to be brought into the picture. Because unless you're physically like looking at your screen all day long, you may not see some of the arrows to stop.

Scott Benner 3:36
I don't want people to stare at their glucose monitor, right? I very much am against that idea. Like you. That's why I like your alerts being set in tighter tolerances, so you can find out earlier and do something sooner. So yeah, so when I first thought it, like when I was and trust me, I didn't sit down in a you know, think tank session and to say, I wonder how I could describe to people I was just, in a moment, my life. And I saw these arrows. And I thought to myself, I gotta stop these arrows. And you know, and I just I have to like Why look at this happening here. So in my mind, I see it as you know, you guys have heard me describe it before I just see it is putting more resistance on the side of direction that the arrow is trying to go, the arrow is trying to go up, I try to put more insulin over top of it to push the arrow back down again, if I if I have an arrow going down, I think of it is putting food underneath it to push it back up the other day. I described it to somebody. So I am going to say something. I need to give myself credit for something. I wish I speak in pictures. I really do. And I know that about myself. And sometimes I'd like you know, I'll do the tug of war thing. And then somebody won't get the tug of war thing and I'll be like, Oh my god, they didn't get that. Alright, I'll say it like this. So I was trying to describe stop the IRS as somebody though today. And I thought they're not getting it and then I said hey, you're a football fan, right? Okay, I said okay, so imagine your offense goes out on the field. The regular offensive line center two guards two tackles and a quarterback behind the center and you get sacked. On the next play, you might bring in a tight end and ask the tight end to help block. Now if you still get sacked, you could bring in a running back and tell the running back Hey, after we say hike, stand up, chipper blocker real quick, knock him off his path a little and then go out and try to catch a pass. If that doesn't work, you might bring in another tight end right. So in some scenarios with insulin, five linemen do the job five linemen can keep back a low blood sugar right keep you from getting sacked or keep back a high blood sugar keep you from getting sacked. But sometimes you need tight ends the block too sometimes you'll also need a running back. So sometimes you have to bolster your side so the other side can't get to you. And that's insulin like like it's just how I like that's just how my silly brain sees it like like so if you're trying to get low, like your blood sugar's trying to go low. That's the defense sacking you you need more blockers and then that Caserio, those blockers are carbs, right in the exact reverse situation. If you're trying to get high, then the insulin is trying to sack you. And you need to keep the insulin away from your quarterback like break, you know, or, you know, I'm sorry, if you're trying to go high down, the carbs are driving you up, you need more you need more insulin. So you bring in instead of blockers you bring in like attackers like people to like push back in the end, you're just trying to keep this this never ending back and forth like this, just like a pirate ship just rocking back and forth. You just asking like you're putting 100 people on the deck of a boat and telling them run to the right, run to the left, or the right run to the left like and again.

Jennifer Smith, CDE 6:46
That is how really you just want them eventually to like run to the middle at all

Scott Benner 6:50
stabilizes our do this, do that. And then eventually, exactly, every hundred people be in the middle and they'll be like, oh, what's our job now we got the boat stabilized

Jennifer Smith, CDE 6:57
standstill.

Scott Benner 7:00
I am totally gonna blow my own horn and tell you I've never had that thought before until I just had it right now because my stupid brain works in pictures. Okay, so that's what you're trying to do. I've in the past described it as scales of justice, but have holes in either side, and you're constantly putting an insulin in one side and carbs in the other and just trying to keep them from flopping down on one side. So any way you can think of stopping the arrows. I don't care, like whatever picture you have to paint in your head. But the truth is, is that if it starts getting away from you, you can't stand there and watch it. Right because then your quarterbacks gonna be out for four weeks with a broken collarbone, you need to do something right. So when so when I see, for me, it's diagonal up at 120. So and that's partly to do with Arden's physiology to a 118 diagonal up that goes to a 120 is about to go to a 125 straight up and Arden I know how that works. I can look at that line on that Dexcom graph and see it coming. So right he hits the 118 I can Bolus Mm hmm. And that stops the arrow. Right. And so now I create a plateau and then I watch it. And if the plateau doesn't come back, then I re address and I get it back again. But in my mind, I just messed up the Bolus for the meal somehow, had I put in whatever amount stops that arrow if it was in up front, the arrow wouldn't move up. Right there were also times Today's a great example, where Arjun texts me and says, Hey, I'm going to get breakfast. And I was like, Okay, so the last three times she said that at school. It's been a muffin. So I put in the muffin bolus that I had figured out. And then like 10 minutes later, she was Oh, hey, by the way, they didn't have any muffins. I got a bagel. It's just like now I live on the east coast. A bagels are a real thing here. It's like a real thing for bagel got still here and I threw it at you. I could kill you with it. You know? Like it's a big dopey thing, right? And it's not all like dry like you and like Indianapolis are thinking right now or you know, like often, like you guys out in California are thinking about I'm sorry, this is like a lump of like dough. Okay? So I'm like throwing in more insulin. I'm like, Arden, this is not gonna work, right. But let's just see what happens. And it worked for a long time, actually, for like an hour and a half. We were ahead of it. And I saw the curve up. And as soon as I saw it, I was like, Oh, god, oh, god, it's coming. And I just didn't hit it hard enough. So now Arden's like 195, and she's stable at 195. And we are putting more insulin on to get it back down. But now I'm also thinking about two things. I'm thinking about this, you know, this stability, stable arrow trying to turn it into a down arrow, and she's gonna eat lunch in 45 minutes

Jennifer Smith, CDE 9:53
and lunches. I was just gonna say lunch is coming for you.

Scott Benner 9:56
What do we do with that? Tell you what we're gonna do with it. We're going to start An arrow, then we're gonna stop an arrow. Okay, so we're going to make a really large bolus in about 30 minutes about 25 minutes before she's going to eat. I'm going to bolus her whole lunch. And, and I am going to try to use her lunch bolus to drop this to start an arrow, right. And then I'm going to use the food at lunch to stop the stabilizer, yes. And then I will reassess about an hour after she's eaten. But there's all different kinds of ways to stop ours. And moreover, to stop the direction and the momentum of your blood sugar. You can you know, I've said it a million times. But you can't just think about how your insulin impacts your blood sugar, you have to think about how your blood sugar impacts the food you're eating, how the food impacts your blood sugar, how the food impacts the insulin like these things all have this sort of like weird symbiotic relationship together. And we get it drilled into our head that diabetes is about a number and making a number go down with insulin. So much, so much more than that, if you know how to manipulate those arrows, meaning the direction of your blood sugar.

Jennifer Smith, CDE 11:15
Well, and you've also, you've also paid enough attention, as you said, if you get that angle the arrow up and it's 118 you know what's coming. And you know what's coming, because you've had experience with paying attention before. So sometimes, sometimes I actually talked to people about even watching to begin with when they're trying to be more bold with insulin, when they're trying to be more aggressive. I say, you know what, if you're worried to begin with, pay attention first, see what happens? See, let it let it go up. See how much once it goes up? How much does it take to bring it back down? Because if this is a consistent, that you're always needing one extra unit after lunch every single day. And even if your lunches a little bit different day to day, you're always adding an extra one, one and a half units. Okay? Well, one, something probably is wrong with your ratio, because we need to adjust it which also then just means you need more insulin up front, right? So we can learn from also watching. And you don't have to watch for a week with aiming for high blood sugar's just to be able to watch, you can do it a couple of times and say, okay, I've learned something here. Now I can be more aggressive, and I feel safe about it. So for people who want a little bit of assessment, that's kind of also a way to do it.

Scott Benner 12:32
That's brilliant and 100% necessary and what Jenny just said, you right, what you just said was 100% needed absolutely brilliant. poignant in the moment, do you want to know what happened in my head when you said that? What I thought Jenny just said, you have to take a strike. Do Yeah, you have to take a strike. So you can see how the pitchers throwing, right because you're going to swing it the first one and Miss anyway. And then you've lost the experience of watching the pitch cross the plate. So sometimes

Jennifer Smith, CDE 13:02
I told in my in my one of our to doing half marathon to get to finally doing like a half Iron Man and a whole full marathon and everything. I took a lot of strikes, trying to figure out what I needed to do to manage. And the strikes. They suck from a like perspective of that mental internal management that you always are aiming for. It's gonna work this time and I'm going to try this and there's going to be perfection, there's no perfection. There's, you get to a point of figuring some things out, like, you know, my long distance running strategies, I've figured it out. And unless something is completely just weirdly off 99% of the time, my strategy now works consistently. But I did I that's a great way I took a lot of strikes, figuring it out. How much nutrition do I need? How much bolus Do I need to shave off? Do I need to change a basal rate during or after? Or how far ahead of time or whatever. And so some of it is it strategizing and I kind of feel like a 30 year guinea pig.

Scott Benner 14:14
I'm gonna figure this out. But you know, it's interesting, it occurs to me like you said, that is it You and I have Jenny and I are interesting. Like we I don't think we have a probably a ton of similarities. But we talk about diabetes exactly the same way and we have the same sort of resolve about it. And it's obviously much easier for me to have the resolve than it is for you because you're living it. I just look at a person and go Yeah, don't eat that yet. Okay, now, she's like, I'm hungry. And I was like, I wish I cared. Just don't eat it. Like it's like, you know, and that and even that like right is crazy. I just I grew up in the part of the country where my I've talked about before, like my dad would have cared if I was hungry if a doctor told right, like you can't eat that for half an hour my dad would have been like, again, I didn't know for half an hour, right? You're walking If you're sad, go tell somebody who cares, you know? And so so I've just enough 1970s parenting and made to do that. But but it is interesting when you and I agree we agree so incredibly like Jenny and I don't have like a like we're not like out seeing movies together. She lives in Wisconsin and I live in New Jersey. Although we are going to get to meet each other in person coming up. I think I think I've hopefully I think I've negotiated Atlanta,

maybe. Oh, lanta. We're gonna we're gonna probably bump into Atlanta. I think it's possible in Arizona. And there's no way I'm coming to Wisconsin and not making them bring you so. So anyway. But I love how much we agree about this. Like when people ask me, like, why, why Jenny? Like, why did you choose to do it with her? I said, Well, I had done hundreds of these podcast episodes. And I would always go back to the two times I had Jenny on every time she spoke, I just thought, wow, I agree with this person. Like, like, oh, and I have my narcissism allows me to believe that I'm right. So if I'm right, you agree with me? You're amazing, right? So I don't know if you're actually amazing. But my narcissism thinks you're terrific.

Jennifer Smith, CDE 16:11
I think you're great to

Scott Benner 16:12
see. And Jenny has that nice accent so you don't hear her being narcissistic. You just hear it from me with my Philly thing going on. I got a beautiful text from somebody the other day that just said, I love when Jenny says carp. Really? Cuz your accent that you don't hear. So

Jennifer Smith, CDE 16:31
I you know, I get most of it. I get for the old when I say something with an O in it like Minnesota, or whatever. You know, I in fact, a lot of people just ask are you are you from? You know, Minneapolis. Are you from Minnesota? I'm like, No, I'm from Madison. I live in Wisconsin. I am from the Midwest. I know it's my accent.

Scott Benner 16:53
They were just like, it's just a taxi said I love when Jenny says carb. I actually got a message while we were talking about Vicki's episode that just says, almonds don't have nipples. I'm laughing because I get a lot of like, while we're recording, I still get my messages from people. And sometimes I'm like, Oh, that's from like another episode. That's so funny that they're listening to that while we're recording this one. Funny, but No, but seriously, I you know, that's it. I think if you and I got married and had 17 kids with diabetes, we would just like, walk in like, we'd be like The Brady Bunch of taking care of diabetes. I just I feel bad for the time

Jennifer Smith, CDE 17:29
without adopting your children. No.

Scott Benner 17:32
I was just thinking about like your poor husband. Because one day you guys are gonna have a disagreement about diabetes. And you're gonna say Scott would agree with me about this. And that guy's gonna be like, who is Scott? And why is it coming up here in our house? Because I hear a lot. Jenny, you have no idea how many notes I get from married women who are like, my husband is tired of me saying the guy on the podcast says we should do. Oh, like you don't find that to them. They won't like that.

Jennifer Smith, CDE 17:58
I'll tell you what I'm gonna do Jenny. Yeah, my husband totally. He totally knows your name and it and you know that we would that we do these. In fact, he usually tries to keep our son coenen who's two and a half and he hangs out with during the day while I'm working and doing these with you. He usually tries to keep them as quiet as he can so that there's not like this big like, ah,

Scott Benner 18:17
like in the background. You name a kid. Come on. He's gonna be loud. You know what I mean? That's a that. You might have done that. Yeah, that's what I'm saying.

Jennifer Smith, CDE 18:26
He is a loud Irish little boy. He is Yeah. He is all about I want it. I can do it. No, Mommy, I've got this. He. He's got it all down at two and a half.

Scott Benner 18:39
Hey, you know what I'm gonna do one day. I'm gonna put a survey online to see how many people with autoimmune diseases have Irish heritage. Because I'm telling you, the pale white people have trouble. Seriously, like, like, you know what I mean? Like, there's something about that part of the world that you know, celiac and like, like, that whole thing is very common through that bloodline. And my wife is, is is English and Irish.

Jennifer Smith, CDE 19:08
So she Yeah, and I, you know, Finland, I'm sure you're quite quite familiar with the studies in Finland being the highest rate of development of type one in the world as far as a country. And from the studies that have been done there. They've really kind of narrowed it to the field of one some genetic predisposition. But from that it has to do a lot with vitamin D. One, they're at a very bad, like, latitude for actually absorbing and being able to have their body produce vitamin D the right way from sunlight. But two, they've also found that there's something within the body, the bodies there that actually it just doesn't develop and so they end up having very low vitamin D levels. In fact, I I can't remember the study when it was done. From when to when it was like 2006 or 2011, up to like 2015 or something where the they started supplementing at birth kids that were born in Finland, and once they started supplementing the rate of increase in development of type one stabilized, it didn't keep climbing. So it's kind of like a standard now is just supplement with vitamin D from birth. I don't remember what the dose or anything was. But yeah, there's, there are some very specific like, cultural populations that are very prone to type one diabetes and Orthodox Jewish are also have a very, very, very high prevalence of Type One Diabetes you ever heard the, the idea that the potato famine created depression in Irish people, the Irish,

Scott Benner 20:55
they there carries on to this day. It that's just like, there's the that's the stuff nobody thinks about, like you don't think about stuff like that in your day to day life? Well, that but there's, I don't know, there's obviously there's different groups of people who have been affected for I mean, listen to what you just said, but their distance to the sun? Or because they couldn't grow food for variable. Was it five years or something like that? They in 1800s? They did. They just ate potatoes that make it freakin sad, that's for sure. Yeah, you know, and then they say it actually changed their genetic code somehow to

Jennifer Smith, CDE 21:28
I wouldn't doubt I mean, the body, the body adapts, you know, I mean, that's why we have so many different animals that have like, you know, developed in the sea, and then they crawled out and they grew legs. And I mean, same thing in the human body. I mean, the real reason that we have some of the teeth that we have in our mouth, is because of where we started out. And now we may not really use those teeth the same way. And you know, it's,

Scott Benner 21:55
I just think it's, it's, it's important to remember when you're thinking about your diabetes, that there are there, we talked about the variables, but there are variables that you're never, you're never going to know. And so that's why I like boiling them down into simple ideas, like be bold, stop the arrows, use more, more insulin, because you if you, you see people sometimes online get frozen, trying to figure out what's happening. And when you get frozen like that you're the person in the horror movie that stops running. And oh, yeah, yeah, you don't want to stop and start screaming, he's got an axe, just right. Just remember, you just run Yes, you don't have to outrun the bear, just your friend. Okay, so

Jennifer Smith, CDE 22:37
don't go into the dark room where the funky noises are coming from escape away from the funny noises, you don't

Scott Benner 22:43
have to figure out all the diabetes variabilities just enough of them to get to the next moment. So like, just try to keep in mind you're not, you know, you're not gonna be able to figure out everything that's going on, but you can figure out enough to live well. And that's sort of my goal for everybody. I am going to stop this and say thank you. Okay. Okay, just a couple things here at the end. First of all, of course, thank you so much to companion medical makers of the in pen for sponsoring this episode. You can go to companion medical comm to find out how your insulin pen could talk to an app on your phone, and then talk to your dexcom CGM help you make decisions about things like dosing insulin on board. A lot of stuff actually, you got to go check it out. It does more than I can just say right here companion medical comm check out the impact. Thanks also to Jenny Smith, for coming on the show. And for sharing her knowledge with all of us. I don't think I've ever made this completely clear. I hope I have. But this isn't an ad like Jenny's not a product placement. Jenny's just the person I love having on the podcast. Integrated diabetes doesn't pay for anything. I just share that with you. Because if you think she can be helpful, I want you to find so integrated diabetes.com to find Johnny. And then I have one last thing. The show is so close to another milestone. I would love it if you guys could share the podcast with just one person who you think really might need it. Love it, enjoy it. You know, anybody? Well, not anybody. Like don't go picking up people's phones and bars and just subscribe. You know what, I'm not gonna dissuade you from doing that. Let me let me restate. I would prefer if you found someone who you thought would really like the show or could use it and got them to listen to it. But if you want to pick up people's phones and bars and subscribe them, I'm not going to dissuade you. I'm going to say I don't think it's right. But I don't feel strongly enough about it to stop 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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