#1001 All About MDI (REMASTERED Diabetes Pro Tip)

September 18, 2023Scott Benner

Remastered Diabetes Pro Tip: All About MDI
Scott and Jenny Smith, CDE share insights on 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 0:05
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. How frequently does someone leave a diagnosis with an insulin pump?

Jennifer Smith, CDE 2:31
I would say never part of the reason for that not leaving a hospitalization or a doctor's office with a pump is because of all of the red tape that you have to sort of go through for ordering and you know that kind of stuff. I would say the rare case, this is probably 10% of the time, maybe even less, somebody's pretty quick to get the order written by their prescriber. And in fact, I worked with somebody maybe a month ago that her little boy was diagnosed and had a pump within about six weeks. Okay, but that's pretty quick. It's not typically that fast.

Scott Benner 3:10
Most people are going to get diagnosed with type one diabetes and leave with either pens or syringes or syringes, right? Yes. And so whether you're a person who thinks right away, I have to have a pump and you hammer through insurance and get it six weeks later. Or if you're a person who gets told, we don't give pumps to people until you've had diabetes for six months, or any of those arbitrary times that doctors throw out one year or until you're in perfect control, then you can have a pump as soon as you know how to do this so well that you'll never want to pump we'd be happy to give you one which will never come and so so people are going to need to know what managing with just MDI looks like so multiple daily injections. These people are going to get some sort of a fast acting insulin that they can use at mealtimes and to try to adjust highs and they're going to get a slow acting insulin that's going to be their Basal insulin. Right? Well, so let's start slow with the Basal insulin. There's a lot of them on the market at this point back when Arden did MDI we were using love Amir, and we found that we had to split it half a dose every 12 hours. How how much of that is really good advice about slow acting Basal insulin, specifically,

Jennifer Smith, CDE 4:25
that what you found with the love Amir as a specific brand or type is very common. Okay. While while the you know the makers of love, Amir will say that it is a 24 hour acting insulin. What we find, especially with the smaller doses, is that dosing twice a day or two injections of it works much more optimally because it doesn't carry a full 24 hours.

Scott Benner 4:54
That was absolutely my finding. I think a lot of people find that so that's the first thing to understand. If you Save yourself every day a certain time my blood sugar goes up. And I can't understand why I bet you it's about 18 to 20 hours after you've injected your slow acting insulin. And so the important thing to remember when you if when you make the decision to split your Basal insulin is that it might not be a 5050 split. So say you have your five units or a one unit, it doesn't matter, it doesn't mean you're going to put in a half a unit and then a half unit again, 12 hours later, it might end up being three quarters of a unit or one and then a half later, there's your because your body has different needs at different times.

Jennifer Smith, CDE 5:37
And that kind of goes into understanding the needs of the different age groups, kids and teens tend to have a much more profound increase insulin need in the overnight like literally like as soon as their head hits the pillow kind of thing and through and into the overnight. So splitting doses for you know, multiple daily injections with the Basal insulin, you may have a heavier dose in the evening than you do with that morning time, the heavy dose in the evening carries you through the increase in need overnight, as well as the morning which is a little bit higher resistance as well. And then your dose in the morning kind of carries you through the day when you're more active, right? And you likely will need a lower Basal amount. And so

Scott Benner 6:23
all we've really said here, and I repeat this a lot to people is that setting up your slow acting Basal insulin when you're on MDI is about amount and timing, right? Yes. We're gonna say this in the next episode, but so make sure you get to that next episode, but you have to balance the impact of the insulin against the action of carbs or body function, right. So it's just, it's about a tug of war between those things. And that again, I'll talk about a little later. And that's where

Jennifer Smith, CDE 6:56
watching you know, glucose values, especially if you are privy to getting a CGM early on, which I do encourage over I've said it a million times to people that I work with, if I had, if I had to decide on a technology piece between CGM and a pump. If somebody was going to take one away, I would 100% Keep my CGM, right 100%. Take my pump, I'll figure out my multiple daily injections. As long as I've got the data and the trend of what's happening, I can figure it out.

Scott Benner 7:25
If you are going to I would 100% agree with you. If you're going to say that one thing is more important than the other, which I think is a bit of a you know, yeah, right. I I'm not looking to give one of them away. But am I by any means when you when you lose your pump when you're using MDI, what what that means is that if you want that kind of like, tighter control, I guess you're going to be injecting more. If that doesn't bother you, then right on, you know, like, that's absolutely fine. You also

Jennifer Smith, CDE 7:53
see what my friend ginger does. Ginger Vieira, who I wrote the book with the pregnancy book, which you know, she long term has been multiple daily injections. She uses CGM. She is not scared to give 1216 20 Micro dosing adjustments through the course of the day to keep things tightly managed.

Scott Benner 8:15
So and I think so I always say the same thing. Here's what you gain with a pump. You don't have to inject all the time. And you now have the ability to manipulate your Basal insulin. Yeah. But other than that, there's no more precisely

Jennifer Smith, CDE 8:27
right, right can manipulate Basil with injected basil, we don't, we don't recommend it. Like we would on a POM it's difficult to difficult, it's difficult to manipulate. But you can use your precision to do that on punk. Yeah,

Scott Benner 8:44
the first time I thought about getting on a pump, and I didn't know anything about them, and I went to a pump class at our children's hospital. You know, even back then I didn't realize that, that my Basal insulin would just be fast acting insulin given by the pump, but in smaller doses, like, like, spread out over minutes and hours, right. And I didn't I didn't think about that. It was explained to me in that room. And then I thought I could shut it off. Like because how many times I thought, Oh, I wish this level mir had an off switch right now. Because it turned it off. She's so stable and she's at but I know she's gonna go down because this, this level here, she's gonna keep working in the background. I

Jennifer Smith, CDE 9:22
don't want to feed her three juice boxes just to prevent it right. Yeah, looking for

Scott Benner 9:25
that. I have become adept at manipulating artisans, blood sugar, with Basal insulin through her pump. But that's not what we're talking about right now. But we'll get to it in a different episode

Jennifer Smith, CDE 9:35
leads in it goes very well with MDI, because you can manipulate differently even if you are on MDI.

Scott Benner 9:44
And so, so I guess the first thing, just very basic ideas you're injecting, you need to pick multiple sites, keep rotating your site you can put in so on and over and over in the same spots. It's incredibly important because you you're Your spa your spots will become saturated you can actually what do they call that when that when you can actually see like bumps under this under your skin from Yeah, it's

Jennifer Smith, CDE 10:08
it's really a either a scar tissue development or potentially fatty tissue under the skin that that light lipo hypertrophy, other big, you know, fancy words for it. But really, it's just when you inject in the same place over and over and over and over again, you're damaging the underlying skin tissue. And it can lead to, like I said, either scar tissue or fatty deposits. And unfortunately, then the absorption in those areas is quite variable, variable, if anything at all,

Scott Benner 10:42
and you could lose your favorite place and never be able to use it again. Exactly. So when your doctor or your nurse practitioner tries to scare you with whatever, Jen, whatever Jenny just said they're like or something like that. Just think to myself, just think to yourself, Well, that sounds scary. What she meant was rotate your sights,

Jennifer Smith, CDE 10:58
rotate your sights, and there you know, there's so many places on the body to use mean the backs of the arms, the lower back the upper, but the legs, the tongue, the tummy, the sides of your tummy. I mean, you've got a lot of places to use. So I think with little kids. That's always a it's a question with parents, you know, mainly because little kids are, there's so little, I mean, Arden was too, right. So it's, it's like it's finding the place on such a little body.

Scott Benner 11:30
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Jennifer Smith, CDE 15:15
absolutely. Absolutely. And that's, you know, even pump sites, then, you know, same thing with rotation. Yeah, yeah, they all need to be rotated. And that becomes the, I think it as an as an omni pod. Plus, there are so many more places that you can put that pod. And easier, especially from the kid standpoint, or anybody who has dexterity issues or whatnot. You know, because there's no tubing, there's no tubing, and you can pop it on. And that's even easier than an injection.

Scott Benner 15:47
I've seen people put them backs of arms. Arden, where's hers, you know, the left of the right of her navel on her stomach, and you can even and she wears them on her thighs. You can even rotate within a rotation. So you could put it on your stomach cannula facing your belly button. And then the next day turn it and you know, put it the other way like you can. If you have four spots, you have 20 You know what I mean? Because you can just kind of start moving around a little bit of grown grown women who wear them on their breasts like that one, like I show that every once in a while somebody will kind of like pull their shirt down online. I said it's the art and art like I've never doing that.

Jennifer Smith, CDE 16:26
Yeah, I've not tried that myself. Although, you know, this year, Chris Freeman.

Scott Benner 16:32
I was gonna bring Chris off. He wears, he

Jennifer Smith, CDE 16:34
wears it on his chest. Yeah. And I know, he also wears it on like his upper back. And I've seen people on many of the like the Facebook, diabetes groups and whatnot. The places that I mean, people wear them on their calf, I've seen people wearing them on their forearm. Now, although not approved sites. Again, this is where your diabetes will vary. And you've figured out what works for you. But you know, yeah,

Scott Benner 17:02
and for people who don't know, Chris is a four time Olympian and a cross country skier. And there is a picture that he shared years ago that is to this date, the most popular thing I've ever put on my website. So ladies, you might want to look at why you're clicking on things. But it's a Chris without his shirt on. And he has no body fat to speak.

Jennifer Smith, CDE 17:23
And just wear the reason he wears it there he does. And my

Scott Benner 17:27
point is he's still pumping and using a Dexcom. And so if someone tells you, you're too skinny for this, or I've heard it both ways, it's so funny. Oh, you're too your kids, too chubby for that pump. Your kids too skinny for that pump. i There have been I've heard a million different excuses. But okay, so MDI, so rotate our sites, what are other good practices around MDI.

Jennifer Smith, CDE 17:50
Other really good practices, make sure you are changing the syringe, if you're using a pen, really, really important is syringe itself, as well as the pen needle caps. In fact, one of a very, a very common practice for people to do is reuse the pen cap. And by reusing, they actually store the insulin pen with the needle cap, screwed on to the pen. Really not a good idea, it can introduce air into the pen. And it can change the way that the pen dialing can actually dose the insulin. So if you are going to reuse the needle cap, I don't recommend doing it. But if you are going to do it, take the needle cap off in between those uses. Always make sure that you're wiping the top of the needle or the insulin pen itself, you know, with an alcohol swab, just cleanliness. Those are kind of the basics.

Scott Benner 18:49
Okay, well, what about and I realized to go back for a second you were starting by saying Don't reuse a syringe, which never in my wildest dreams even occurred to me, but you're telling me people do that, too.

Jennifer Smith, CDE 18:59
People do that. Absolutely. And, you know, having worked with people across the spectrum of economic setting, just like insulin is expensive. I mean, even though a box of syringes is not expensive, even off of the shelf, it's not expensive without a prescription. Again, it may be something that people are reusing because it's an expense that they could decrease

Scott Benner 19:27
somewhere, right? You know, so if you can avoid that, please do. So I have a question and here's a good place to put it. I'm probably gonna bring it up again when we talk about pumping. So the quickest story would be that one day I took off Arden's pump and I saw little redness under where the adhesive was. And I was quite literally standing in my house, rubbing my hands together thinking because I was scared oh my god, is she allergic to this adhesive and we can't pump anymore and like my brain was racing, and I'm rubbing my hands together and rubbing my hands together and as I was doing and I thought, Why are my hands so dry? And then I realized I'm constantly touching alcohol. Yeah. And so I do a little research and I find out that in Europe, it is not common practice to clean anything, a site with alcohol. And I was like, huh, so I stopped doing that. And Ardennes never had that problem again, and my hands don't crack as much in the wintertime. And so is that a lawsuit? Decision? Like do you say to somebody clean this with alcohol first? Because every once in a while someone's gonna get an infection? Or why do we teach it and some other places don't?

Jennifer Smith, CDE 20:42
Alcohol itself is not a I guess the best thing that that I can call in layman's terms, it's a degreaser. It literally wipes clean, that area of any grease, any any skin, moisture, any lotions, anything that could be on there. It's it's not antibacterial, okay, it's wiping the area clean. Sure, right. But the real reason for cleaning the site is just to make sure that you've, you've taken care of anything that could be there. And as far as adhesive component, it's very likely, of course, that the adhesive isn't gonna stick as well as if you've got body lotion on it. Or if you haven't taken a bath in two days, and you're putting it on your skin and your skin has done its normal thing, and you've got oily skin. So the adhesive isn't really going to stick as well. What do I tell people, I also do not use alcohol. Oh my gosh, a CDE. That doesn't use alcohol swabs. But I do, of course, have a clean site. And by clean sight, I make sure that I wash the area. Soap and water, make sure that it's clean, dry it and that's what I you know, apply on top of then you're entirely 100%. Right? Alcohol is it will dehydrate the skin and used over and over and over, especially for kiddos little kiddos who have very sensitive skin to begin with. You're just asking for more. I mean, there are skin barriers, if you do truly have, you know, a slight problem. But yeah, even for injections though, making sure that the injection site is just clean. I mean, obviously, if your kids been outside rolling in the mud or in the sandbox or doing whatever they've been doing in the rain puddle, clean the site.

Scott Benner 22:37
We do the same thing, I use warm water, a clean towel, a clean towel to dry it, let it air dry, something like that. It goes on, you know, schedule your pod change around your shower, you know, get out of your shower, pod change. Sometimes, you know, I see some people like they call them naked showers where they change all their gear, they take it off before they jump in, they're free. They're free for a couple of minutes and they jump out and they do it then there's a bunch of different ways to do it. But I think the important thing here is to use your common sense, right like to and that's all I did that day, I thought I'm drying her skin out and then throwing this adhesive on top of her No wonder there's a reaction here. Absolutely. There is a wonderful post on my blog about how to treat real severe at ease of allergies it is is one of the most popular posts over the last five years. And I'll link it in this so that people can find it was written by a mom who devised a infallible plan. And when you see the pictures of the reaction that her poor kid was having, it was an all over body reaction. And she figured out a way for it not to happen and him to keep using this stuff. So that was really good. I remember the first time Arden was in like a thin pair of like yoga pants as like a four year old and or a three year old or four year old and I wanted to give her a shot in her leg. But we were out and I just was like, I'm just going to jab the needle right through the pants. And that's what I was like, Okay, maybe all these rules aren't that important. And you know, and so she was like, Oh my God, what are you doing? And I said, No, it's fine. I brought it up in you know, now I say I've done that in the past and she was mortified. She's like, why would you I was like, listen, we were in the mall, you know, like, like, what do you want me to because I and here's something I really believe. And I think this is a great place to bring it up. I don't think you should hide when you give yourself injections. I think I agree. I think that not just not hiding. But why in a public place? Would you go to what is arguably the dirtiest, the bathroom to open up a hole into your body?

Jennifer Smith, CDE 24:45
Absolutely. kind of goes along with nursing for women. Why should you have to go to the bathroom to nurse when it's the same thing? It's the comfort level of other people. It's not your comfort level that you're worried about? got

Scott Benner 25:00
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Jennifer Smith, CDE 26:25
Level of other people. It's not your comfort level that you're worried about

Scott Benner 26:28
exactly. And so let me tell you the briefest story. I'm in a restaurant one day with my kids. And we're leaving that day and there's this little girl seriously a little girl injecting at her table. And I stopped at the table none of my business I said excuse me. I just wanted to May I say something and they looked up at me in horror I realize now and I said my daughter has type one diabetes too. And I want to say good for you for injecting here at the table. There is no reason for you to hide. You're doing a great job, little girl like last year. I had to do the math. Last year, seven years later, I had to make a phone call about jury duty. And I said look, I would like to skip jury duty because I'm the sole caregiver for my daughter, I help her make her insulin decisions. And if you listen, if you'll let me be on my phone while I'm there, I don't care. But if you don't want me on my phone, I need to ask the skip. And the woman says oh, I completely understand. My daughter has type one diabetes too. And I gave her my name. And she says is your daughter's name Arden and I was freaked out and I thought Yeah, why? And she goes, I read your blog. And I said great. She goes actually you're going to find this strange. You've been a real help to my daughter through her life. And I said why? And she said, Because you bumped into us in a restaurant. The week she was dying. The week she was diagnosed, and you told her she was doing a good job and she shouldn't hide. And she's like, and it's been such a big deal in her life. And I was like, wow, that is so touching. I'm gonna get out of jury duty. Right? And but, but absolutely 100% on a story. Like don't, don't hide, you know, and because Jenny's right it is for other people. It's not for you, and it quietly you'll you feel shame, like it quietly will make you feel shameful about what you're doing. And you should not be ashamed of having type one.

Jennifer Smith, CDE 28:28
Not at all. It's just like, you know, I mean, everybody wears it. I mean it kind of goes along with everybody wears their pump differently. And there are a lot of people especially Omni pod wearers who wear them you know, only in like, unseen locations, man I like I wouldn't buy pods they're get decorated with stickers and I used to like color them with markers and now that I know that you know we have the 3d printer kind of thing. We don't but I ordered a Wonder Woman 3d print pop snaps it snaps over the top. It's awesome. I actually let my six year old pick it out because he was like wow, all those are cool. You have to get wonderful mom You're wonderful. I was like great.

Scott Benner 29:16
But Mommy was gonna get flowers but okay.

Jennifer Smith, CDE 29:19
Exactly one of my favorite places to wear it is on the back of my arm because honestly because it isn't visible. Yeah, not like the other places on my body aren't good. It's just I like to wear it good spot visibly, you know,

Scott Benner 29:32
I would tell you that Arden has in the past seen other people using insulin pumps on the pod and CGM and it she's not the kind of person who runs around excited about it but it has quietly given her a lot of comfort.

Jennifer Smith, CDE 29:45
Yeah, yeah. It's always fun to when you run into die I call it diabetes in the wild. Like you run into somebody at the grocery store who's like, you know, boldly got their pump like hanging off their pants or you know, clipped to their jacket or you know, something like because I've, I always reach out, I'm always like, hey, you know, look, you know, pumps, we've all got pumps, and it kind of starts up a conversation. And it's, I don't know it just because diabetes is so like, it's such a silent unseen. For the most part, it's just a nice way to bring it to have visible

Scott Benner 30:19
and make it make it normal because and here's why that's important. I interviewed a singer a long time ago, a Broadway singer named Kelly. And if you go back and listen to Kelly's episode, which I'll link in the show notes, she hid for a long, long time, and it was not good for her. And when she finally decided not to do that it was freeing. So I'm saying don't put yourself in that position to begin with, you know, just be yourself. And, and this is who you are. And look, I'm not judging you, if you can't bring yourself to do it in public. I'm not saying you're a bad person. Yeah. But I'm saying if you can do it, do it. You know, I think you'll be happy with what happens. So, okay, so what are we not? I haven't, I haven't injected insulin in a really long time. So let me tell you one thing that happens to me all the time, every once in a while when I have to give a needle, I'm not good at it. rd tells me I'm not good at it. And so what what is, like, what should I be doing? Is there a pinch? Is it quick? Is it slow? Like, what's the right way to stick that needle in there?

Jennifer Smith, CDE 31:27
Do it? Yeah, I mean, you know, obviously, the age old recommendation is to pinch up. To put the needle in, when I was initially diagnosed 30 years ago, we were told to inject at an angle almost at like a 45 degree angle. Quite honestly, now the the recommendation is just like most 90 degree pump sets, just straight up, putting it straight in, no angle is needed. A lot of people have question too, about the needle length, and all of the research and studies that have been done. Regardless of body type, and body stop body size. Even those really, really, really micro looking needle lengths, they give you the same, the same ability to put the insulin under the skin in the place that it needs to be, which is the sub q tissue, like the that kind of fatty layer for absorption. So pinching up the skin, putting the syringe or the the needle that's on the the pen straight in 90 degree angle, and then just push the insulin in,

Scott Benner 32:37
that I have to keep the needle in for a second or is that a pen thing?

Jennifer Smith, CDE 32:40
That's for the pens, really, the recommendation is it does vary. I've heard people being told that they're supposed to count to 20. I've heard people say that they're supposed to count to five. When I was initially educated, we were told that to tell people count to 10. So that is what I educate with. And it's interesting because if you have ever given a syringe injection versus a pen injection, you will notice a difference if you pull that pen needle out right after and you don't give that count to 10 the insulin can leak out. Okay. So that's the reason for that count. And whether it's a Basal insulin or your rapid acting insulin or a regular insulin. If it's a pen, you do need to do that count.

Scott Benner 33:27
Okay. All right. Let's see what you think of anything that I'm going to ask you about because I'm at a disadvantage when talking about MDI.

Jennifer Smith, CDE 33:35
Um, I mean, the only kind of, you know, Basal insulin, of course, rapid acting insulin, you know, there are multiple of them on the market. There also is still some use of regular insulin which we called short acting insulin, it had a longer profile of of working in the body, then our rapid acting insulins have, it also didn't work as fast. So again, this is where figuring out what your needs might be, for the most part, the rapid insulins on the market, the three age old ones, you know, human log Novolog, a Piedra, technically, they're all supposed to work pretty much the same way. I can tell you my personal n of one is that human log and Nova log work pretty much the same for me, a pager does not I've tried it, it doesn't work the same for me. Then there's also of course, the ASP, which is faster acting insulin aspart, which is just faster acting Novolog insulin, it does have a faster onset of action, and has, in my experience, having used it for a bit of time, it seemed to have almost a more clean finish to working. It was done and that was kind of the end of its actual Elon by Basal was kind of kicking in and doing what it was supposed to do. But you know, determining what again, works for You insurance wise, many insurance plans have a preferred or a tiered kind of both basil and rapid acting insulin for you to choose. monetarily, if you can go outside of you know, tier one or tier two, most insulins are tier two. If you can go outside of that, they'll usually be a tier three and your copay is just going to be more. But if you prefer one over the other, that might be the course of action you have to do. If you can't, then you're kind of stuck using what the preferred is.

Scott Benner 35:30
Okay? And I'm going to ask you one question, and then we're going to switch to another episode and talk about insulin. So the one thing I've found is that when I talk about Pre-Bolus, sing with people, and you know, Pre-Bolus thing is a pumping word, it just means putting your insulin in before your food, right. So you can you can pre inject you call it whatever you want. But but some, but a lot of times, what you'll hear from especially parents is I don't want to inject them twice at a mealtime. And I say, Look, I understand that, but but if you can't be sure of how much insulin or how much food the child is going to eat, you still need to get some moving first. So if you're on MDI, and you're seeing crazy spikes at your meals, it's because you're not Pre-Bolus thing, I'm guessing, or a lot of other reasons that you'll hear through the next bunch of episodes. But you're gonna have to make that leap in your head like I'm going to if I can't trust he's going to eat all this or she's going to eat all this then I need to put some in now, and some and later, right. Please remember that the Juicebox Podcast wouldn't be possible without its sponsors for today's episode on the pod, and Dexcom Dexcom, the makers of the G six continuous glucose monitor, and of course on the pod is the tubeless insulin pump that Arden has been wearing for over a decade. You can go to my on the pod.com forward slash juice box get a free no obligation demo of the pump sent right to your house. Or you can go to dexcom.com forward slash juice box to find out more about art and CGM. Heck, you could do both. The next episode of my series with Jenny Smith is called all about insulin. And it's available now at juicebox podcast.com. are right there in your podcast app. If you're enjoying the podcast, please leave a rating and review on iTunes and take a moment to share the show with someone who you think it can help. Thank you for listening for being bold with insulin, and for remembering that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, and to Always consult a physician before making any changes to your health care plan. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at GE Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com Ford slash juicebox. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years, and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are I'm going to tell you now, Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus. Episode 1004 Temp Basal 1005 Insulin popping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees. In Episode 1015, Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two, in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022, weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talk about transitioning from MDI to pumping. Before I go, I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer, he'd really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.