#1003 Pre Bolus (REMASTERED Diabetes Pro Tip)

September 19, 2023Scott Benner

Scott talks about the importance of pre-bolusing for people with diabetes. He is joined by Jennifer Smith, a registered dietitian and certified diabetes educator, who shares her insights on the topic. They discuss how pre-bolusing can help ensure that insulin is well-timed with meals.

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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 0:04
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. 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's 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. 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 juice box 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 pen, find out more at G voc glucagon.com forward slash juicebox. In the episode about insulin, I told you that that my nurse practitioner CD told us that fear of insulin was the biggest sticking point for people making good decisions with their diabetes, right. And after I got past my fear of insulin, the next hurdle I had to get past was Pre-Bolus. And I am now years and years later at a time where I will tell you that if you do not Pre-Bolus a meal, the likelihood of success is near zero. And if you have success without Pre-Bolus saying all that means is that you gave yourself too much insulin prior to that. And it's just catching up now. And so this is it. We're going to talk about Pre-Bolus and we're going to talk about how about insulin action right the action of the insulin and how to balance it against the impact of the carbs or your body function. So tell me let's go over the part that people aren't going to find comforting at first right which is the amount of time it takes insulin to begin working in a person varies person to person and insulin to insulin is that pretty fair to say?

Jennifer Smith, CDE 4:25
It's pretty fair to say yes and insulin to insulin. I would definitely say most of the the rapids on the market should be fairly similar okay? The rapid acting insulins on the market and their time of action should be fairly similar now. Person to Person yes, that may vary situation to situation as well as situation it may vary but again, that's the learning part of it.

Scott Benner 4:54
Okay, so person the person could end up meaning just your body chemistry could mean where your infusion set is right, you know, your your injection site,

Jennifer Smith, CDE 5:03
absolutely. Say

Scott Benner 5:04
you're a person who gets stuck on, I always injected my belly in the same place, that spot might not be as reactive to the insulin as if you would just try a new spot. If you went to a new spot, it might work quicker than it has been in your old spot. Right? If you're wearing an infusion set it could we alluded to it before you could get better action from your insulin on day one than you do on day three or better on day two, then, you know, two hours after you've put it on, there's a lot of different variables. But we're speaking generally here to you'll apply them to your variables later. Now, if you've heard this podcast before, you'll know that I have alluded to how insulin works in a number of different ways. So I'm gonna give my kind of cartoony description of it, and then we're gonna let Jenny talk about it for real

Jennifer Smith, CDE 5:50
cartoony, might be better, actually, we'll see.

Scott Benner 5:52
So here's how I pictured in my head a couple of different ways. The first way is I think of a tug of war. And I imagine a rope with a with a flag hanging in the middle of it. And on one side of this tug of war rope is insulin. And on the other side is your carbs and your body function. It could be adrenaline, it could be fear, it could be anxiety, whatever it helps to drive your blood sugar up. That stuff's on one side of the rope. The insolence on the other side, unlike a tug of war in a schoolyard, our goal is not for one side to win, our goal is for them both to pull and pull and pull until they get exhausted, they both go, I can't do this anymore, and they dropped the rope and our flags still in the center. That flag represents the blood sugar. You start at when the impact of the carbs begins in my mind, so I'll explain a little more. If you let them both start pulling at the same time, the carbs are generally speaking, going to gain power and momentum before the insulin begins to work. So now your rope is going towards a high blood sugar and you're you're starting to head up. Now suddenly, you're 50 points higher. And what if you started with 150 blood sugar, now you're at 200. And now these carbs have momentum. They have speed, they're pulling your blood sugar up. Now all the sudden, 1520 30 minutes later, the insolence like, oh, no, no, wait, I have a job to do. I remember and it kind of comes online. But now it's pulling, it can overpower the the momentum that the carbs have created. Plus, you now have another 100 points of blood sugar to contend with. And all you have is the insulin that you counted your carbs for. So even if you counted your carbs perfectly, and realize that this meal is five units, once the momentum of the carbs is rocketing your blood sugar up, once you have a number that is higher than you started with those five units are not even going to begin to cover what's happening, let alone the food that you've put in. But if you put the insulin in first, and let the insulin come online slowly and begin to pull down and create the momentum in the other way, then you flip the script. And now the carbs are fighting. So instead of having a fight at 180, blood sugar, you're having a fight at an 80 blood sugar. And instead of your blood sugar falling at 80 It's being the attempt is that it's now trying to be pulled up by the carbs. And that's how when you see people with a stable graph, that's how they're doing it. And so for me, in a perfect situation for me, my daughter's blood sugar is diagonal down when I give her most foods. There's differences you know, food to food, situation to situation but in a perfect world. To me, that's it, you want your insulin working, your blood sugar trending down, creating some momentum down, when you allow the carbs to begin to pull up. Correct. Now, you to explain that in a technical way that sounds

Jennifer Smith, CDE 8:54
and in most in most settings, yes, that's 100% I mean, insulin, our rapid I've always thought that rapid is such a misnomer. Honestly, rapid indicates like now rapid is like you know, click, click click light switch. It's on, it's working. And it's you know, still education is take your insulin and start to eat. I mean, even from most endo offices, it's take your insulin and start to eat, it's going to be working very, very quickly. That's not the case and anybody who's been taking insulin long enough, and you've seen the spikes, and you've seen the issues, despite counting your carbs as precisely and weighing them and everything and you're still seeing these issues. It's the mismatch of insulin timing. It is so our rapids take anywhere between about 15 to 30 minutes to really get that active peak, not peak but that active phase where then when you start putting your carbs in there They will match. As you said, the carb digestion will start to match with the insulin, you'll get a nice gentle curve up. And it should then start to curve back down. And there is a lot of, there's a lot of education that also focuses on, as you mentioned, watching for that curve down, watching for the curve down to start so that you know, the insulin is already moving things.

Scott Benner 10:30
Yeah. And to give you some context that a person I spoke about in a previous episode, who was having trouble, told me, but what am I gonna do, I'm going to be scared. I said, well try it a little bit, this time, and then a little more next time and a little more next time and go forward. And, and so I always tell this story somewhere. And I think here's the right place to tell it. Prior to glucose sensing technology being a thing that anyone knew about prior to Dexcom, I was again in the office and the CD says to me, Hey, you're gonna get one of those Dexcom things. And I thought, I don't know what that is, you know, and she starts telling me, it's a continuous glucose monitor. And I'm like, Yeah, I again, don't know. And then she tells me this simple story. There's a 17 year old boy in her practice, who loves candy, certain kinds of candy, and he can't figure out how to Bolus it. So he gets a Dexcom, whatever the first one was, I don't even remember anymore. His whole goal was to eat this candy without a spike. So he goes out to the store. And he buys like little grab bags of these candies, and a number of them enough for a week and every day starts on this experiment first day, just like you said, eats, gives himself as his insulin, just like he'd been told his whole life, blood sugar goes up to 20, something like that sits there forever. Eventually, he has to give himself more insulin to bring it back down again. Next day, he tries a little sooner, give himself a few minutes, 510 minutes gets a little less of a rise. So the next day, he goes even sooner. And then before you know it, it's a little sooner, a little more, and he starts adjusting it back and forth a little more a little sooner, a little later, until one day, he eats the candy. And his blood sugar never moves. And she tells me that story. And I thought immediately Wow, that means it's possible. Yeah, that was the first time I thought I was like, if that kid can do it with candy. I can do it with anything. Like anything, right? And so yes, give me that CGM place. And I got it. And I started dispense with my fear. And I started learning about it. There were hiccups along the way, right? I've given her insulin, and she's gotten lower than I meant to for two when she's eating. But you know, once twice, I'll go back to this over and over again, when something goes wrong. It's not a mistake. It's a learning experience. It's data for next time. Right? Right. So I put the insulin in, and she goes down to 70 and sits at 70. While she's eating. It's beautiful. You know, like, there she goes. And then and then then a spike. Even if I really messed up on the amount of insulin, I used a spike takes you to 120. Right? Right, right. It's not right. It's just, it's all about that timing and amount. And I repeated over and over again, that you all the things you and I are going to speak about all the things that people hear about on this podcast, if you want to know how to use your insulin, at its core, the very first step is timing and amount. If you get used the right amount at the wrong time, you can use the wrong amount at the right time, that it's too much, you have to have the right amount of insulin at the right time, you have to balance the action of the insulin against the impact of the carbs. If you do that, I don't want to say it's easy, because that's insulting to people. But let me just say I don't think about diabetes that much anymore.

Jennifer Smith, CDE 13:44
It's easier, it's much easier if you do that. It is easier. Absolutely. And it's a lot more. It gives you a lot more visual than to understand. Because it's not so much of an unknown Well, gosh, I counted the carbs and it took the right amount of insulin and this is always happening to me. Why. And if you can start to put those pieces together, it's not a wi anymore. It's like turning the light bulb on.

Scott Benner 14:16
Here's how I explain what Johnny just said, touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org Go up to the top of the page where it says programs there you're gonna see all of the terrific things that touched by type one is doing and I mean, it's a lot type one it's school, the D box program, golfing for diabetes, dancing for diabetes, which is a terrific program you just click on that to check that out. Bowl for a cause their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one touched by type one.org or find them on Facebook and Instagram. links in the show notes Lynx at juicebox podcast.com To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series, touched by type one.org. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter will you use my link you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing an easy to read screen, it fits well in your hand, and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips, then you're paying now through your insurance. Contour next one.com forward slash juice box free meter go get yourself a free starter kit. while supplies last US residents only. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G Bo Capo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Here's how I explain what Johnny just said. I think of it as this equation that it's a mathematical equation that doesn't have any math in it. I did this that happen. So next time I'll do more less sooner, you know, little less little more, that kind of thing. And I always just I always just keep looking at it like that. I did this and that happen. It's the idea of being in a fistfight and you want to hit first because now you have cause and effect. Right? And if you and so now you know I've done something. And that's what happened next. Now I can make a good decision about what what I do next, instead of waiting for diabetes to do something to you. And then you're just covering up your face hoping not to get knocked out. Right? Like because you don't know what's happening. You don't know why it's happening, you have no context for what's going on. But when you make the first move, you can be sure that what happens next was impacted by what you did. I put insulin in 10 minutes before you ate 10 minutes before I ate. And my blood sugar went to 150. So the next time I'm going to try 15 minutes. And if it goes to 130 I might try 20 minutes. And you know if I get low than later, I might say okay, I might need a little more a little less. Now here's where people always say, Well, how much Scott How long? You know, give me the time give me the amount? That answer for me. It's always going to be I don't know, figure it out for yourself. Okay, you have to

Jennifer Smith, CDE 19:04
this is the starting place. Yes. This is where to start. This is how to start. You have to do your own. I mean, diabetes is a science experiment. It's a daily, I feel like every day you're almost given like this new petri dish. And you're told, keep the dots growing purple today. Okay, let's work on keeping the dots growing problem is that something green pops in and then these like little horny pink things pop on? You're like, oh, no, but it is it's like it's a science experiment that for the most part, when you figure out what does work, the timing around the most typical foods that you eat and whatnot. It takes a lot less thinking out of the equation.

Scott Benner 19:46
Yeah. And while this isn't about Pre-Bolus and it will come up later, but it's important for me to say because I think this is impactful. When you really stop and think about your your habits around food. They're pretty similar Right, right. So, you know, you're not I always say like this, like, if you're a person who gets a pizza on a Friday night and has two slices, you don't suddenly next Friday have seven slices. You don't go from being a two slice person to a seven slice person, right? Like, yeah. And so, so you can start making these decisions about how much insulin and when, and you can make them based on Yes, historical knowledge about what's going on. Yes,

Jennifer Smith, CDE 20:24
I usually tell people as the Pre-Bolus piece, you've got, most people have about 20 to 25 foods that are the most common for you to eat regularly. Yeah, that's at least 80% of your control there, at least. So if you can nail the Bolus timing around those and figure it out, for the most part, you know, variations in setting will happen, whatever, yeah, but for the most part, if you've figured that out, you're also much more likely to be able to figure out food that isn't your norm, because of the similarities to what you've chosen. And what you're usually eating, because you

Scott Benner 21:09
can stay flexible, I call it saying stay fluid, right? So here's, here's where I'll tell people this, don't get mad. I don't count carbs. I actually think about it a little backwards from maybe how most of you think about it. I don't look at the food and say, you know, weigh it or measured and say okay, well that's 25 carbs. And my pump says that I get one unit for every 10. So that's two and a half units. In honesty, there is no accurate insulin to carb ratio set up in Arden's pump. We don't even I don't even pay attention to that. I look at a plate and I say to myself, that's seven units. I think that if she's going to sit down and gorge herself on nachos and cheese, the last time that happened, it took 10 units. But I think of it as insulin, not as carbs. And of course that takes a little practice, right? It does, it does. And it is a little contingent on you having a CGM. I'm not going to lie about that, right, because I start with a healthy Pre-Bolus. And healthy would mean in amount and time. And then I watch her CGM, and I don't really watch it, I have her tolerances set tightly enough that if she leaves that range, I find out about it. So as an example, if I were to give art in something incredibly carb heavy, I might use a Temp Basal increase, and a Pre-Bolus to try to spread out the action of the insulin across this timeline where there's going to be these carbs, right? If I make a Bolus, and 30 minutes after I do it, she's 121 30 Diagonal up. I look at that line. And it tells me something based on my previous knowledge, it's I say to myself, ooh, this I missed, like, this isn't enough insulin, and I will give her more I will bump it and nudge it back. It's not a ton more, it's enough to stop the arrows,

Jennifer Smith, CDE 23:06
right. And the arrows are very important to bring up in this in this as well. Because if you are using a CGM, those arrows do indicate a rate of change. And again, that's not something that most people realize. They don't understand that and not understand and people won't tell us but it's that they've not been told they've not been told, Hey, these arrows tell you that you're increasing by 30 to 60 points in the next 30 minutes. Okay, if that's the case, and I know what my kind of correction factor is, or whatever, I can say, Okay, I'm going to need this much more insulin, because if I don't correct my rising 130 blood sugar in the next 30 minutes, I could be 30 to 60 points higher. I could be as high as 190. I don't want to be 190 I've obviously miscalculated someplace, I can throw in a bit more insulin to counter that expected and stabilize it. Yes. Yeah.

Scott Benner 24:02
It very much. It very much is remembering to like I guess the way I usually say it is that you have to trust that what you know is going to happen is going to happen. Right? Yeah, you see. And I think that the least important aspect of what the Dexcom does is the number. It's the direction and the speed, direction and 100%.

Jennifer Smith, CDE 24:29
I wish more please say that again. It is the direction it's the trend. It is not just the number.

Scott Benner 24:38
The number is nice, like don't get me wrong. It's a starting point. But, you know, if you're 60 and stable, and you haven't had insulin for three hours, you haven't had food for three hours when maybe you could get away with like a Temp Basal decrease of 100% for half an hour, maybe you'll rise to 90 Right? But if you're 60 and you're falling well Then you don't have enough time because as we've now discussed over and over again, insulin doesn't begin working right away. Also, Temp Basal is our insulin. It's funny how people think of bolusing. And Basil is different. But once you're on a pump, it's the same thing. You can't just turn your basil off, and it starts happening right away,

Jennifer Smith, CDE 25:16
takes about 60 minutes for circulating insulin level to be different.

Scott Benner 25:20
And I always write and I always try to think of it a little bit as like Ardens Pre-Bolus. Time Like if Ardens Pre-Bolus time is 20 minutes, well, then setting a Temp Basal is not really going to start working for at least 20 minutes plus, it's a fraction of the Basal rate, if, if you're getting a unit an hour, and I say to it, okay, let's double it, let's double it to two units an hour, that impact of that doesn't begin for 20 minutes or so plus, it's not the whole unit extra. It's the it's the fraction of it. So when we talked about basil, we'll get to that. But so Pre-Bolus thing is really just the idea of balancing, again, the action of the insulin against the impact of the carbs, giving yourself a chance, not letting the carbs wash you away, because here's what happens when the carbs wash you away. Count your carbs exactly right, you put your insulin in, you spike up the 200. When that happens, that insulin was only for the food. It wasn't for the 200 blood sugar, and it wasn't for the momentum of the rise. And so when I see that, like, I guess an easier way to say this when when I don't have time for a Pre-Bolus. And Pre-Bolus thing to me is never about the number, you can Pre-Bolus a 65 blood sugar, you know, you can Pre-Bolus a 90 blood sugar because still no matter what, if you're stable at 65, the insulin you put in, it's not going to start working until it starts working. So you have and so don't get me wrong if I see a 65 blood sugar and an artist needs 10 units for what she's eating. I don't put all 10 units in at a 65. I might do an extended Bolus which we'll talk about and extended Bolus but I get some insulin moving, I make sure the insulin is on the winning side of this tug of war to start. But in a situation where I can't Pre-Bolus Let's say I know the meal is five units. 100% certain it's five units. But for whatever reason life, let's call it I can't Pre-Bolus and Ardens. You know, I'm going to start eating right now. I'll give her seven units. Because I Pre-Bolus for the food, the five units for the food I knew. And I pray. And I'm Pre-Bolus seeing the rise I know is coming and the end, the number I know is coming. So I'm already treating a high blood sugar that hasn't happened yet. Because I know it's going to happen. Because I didn't Pre-Bolus Right.

Jennifer Smith, CDE 27:45
John Walsh goes into detail about what you're doing in a little bit of a different way. He calls it super Bolus I call for bolusing. Yeah, and he calls it super Bolus in the way that you take that five units, let's say in your example. And let's say your basil behind that meal for the next two hours is one unit an hour, you actually take your basil running for the next two hours, and you add it into the Bolus for the meal and you take it all upfront. And then to decrease the chance of being too low leader. Because of so much upfront action and the blood sugar staying normal, you actually set a temporary Basal decrease, he recommends starting with 100% Because you've loaded that onto the front to avoid a low but on the back end. Some people find though that attempt Basil 100% off is too much. They only need a 50% they still call the spike and prevent it. But in the back end, they're not having a low then. So similar kind of concept. Yeah,

Scott Benner 28:49
I consider that trading Bolus for basil. So So you know, say 120 Diagonal up 3040 minutes after a meal and I go oh, geez, I got to stop that arrow. How much do I Bolus to stop there? I usually Bolus an hour's worth of a base of Basal insulin. That way if the arrow stops and I stay steady, and she doesn't go down, I say okay, well obviously I was just wrong on the initial amount. But in those situations where you push the button, you know the unit and a half goes in, and five seconds later the arrow goes from 122 Diagonal up the flat you go oh, I didn't need that. Right Temp Basal off off half hour. All I've done is trade the basil for the Bolus. Absolutely. Here's a good place to say this. And we'll say this in each of these little vignettes. Never suspend your basil. It's always temporary Basil is when you suspend your shutting your pump off when you shut your pump off.

Jennifer Smith, CDE 29:41
It does not turn back around. You have to remember to turn it back on. Yes, yep.

Scott Benner 29:45
It's always temporary because you can set a Temp Basal for a half an hour or an hour, two hours but at the end of that time, it goes back it'll go back on to start delivering your basil it's always temporary Basil is not not don't suspend your pump. Oh Okay, so I think Do you think we covered Pre-Bolus there?

Jennifer Smith, CDE 30:02
I think that's pretty good. Good. Yeah, that's awesome.

Scott Benner 30:08
I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free Contour Next One 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 G Vogue glucagon.com forward slash juicebox you spell that GVOKEGLUC AG o n.com. Forward 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 has 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. 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 you're starting over episode 1001 all about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bump and 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 an 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. It 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.