#1011 Exercise (REMASTERED Diabetes Pro Tip)

September 23, 2023Scott Benner

Exercising with type 1 requires extra knowledge.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - Radio Public, Amazon Alexa or wherever they get audio.

+ 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 0:04
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. 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 Penn Find out more at G voc glucagon.com. Forward slash Juicebox. Podcast I liked your idea, a lot of beginning ideas around blood sugar management with exercise because I hear from people constantly and I always think that my answer to them is incomplete. Because it's one of those things that I think I just know how to do. And I don't know why I know how to do it or why it works sometimes. You know, I everyone who listens to those at Arden played really competitive softball for years and years and years. And that that means at this part of the country, that means being outside in incredible heat. weekend after weekend, sometimes from 8am to 5pm playing 234 softball games, right? And I strive for a nice blood sugar around 90 Or I don't change my goals because of what she's doing. Right. And I also am not much of a pre planner, but I do I have spoken to people who are like, look, you know, I'm an adult, I'm gonna go to the gym at five o'clock after work, I need my blood sugar not to fall at five o'clock when I start working out or later sooner. And how do I do that? And I have to tell you, I know it's around Basal insulin and pre, you know, basically like setting Bezos up ahead of time or afterwards to catch lows and stuff. But I'm so reactive. I don't think about it that way. So how do you talk to people about it?

Jennifer Smith, CDE 3:42
Yeah, you don't really have a I mean, as you've done for a long time, you're sort of like, you're surfing the wave of what's happening for art and and you're managing very well doing that, because you've intuitively learned how she reacts to things for the most part, right. But to teach people in a general sense, I think one, you said it correctly. I think it's around basil. Well, you're you're right in that it's around insulin. Most people,

Scott Benner 4:10
my son, my son just well. I'm recording.

Jennifer Smith, CDE 4:16
So the the insulin is really a big piece and a lot of people again, they focus on a number when they're going into exercise, but they're not focused on what's what's the causative to that number, what's affecting that number and where it may directionally go. So we talked about, you know, your person here example wise, who's going to exercise every day at 5pm. Well, for them, that's kind of a nice timeframe of the day because the goal there in a simplified way, would be no active insulin on board, so no Bolus insulin, you know, and they let's say as an adult, they only eat lunch at noon or one o'clock technic by five o'clock that Bolus should for them. most part unless they're looping, that should be gone. Right? And it would mean then, you know, aiming to either not have an afternoon snack or in which there's no Bolus that would be writing into the exercise. And then the Basal component, there is a lot of debate about should I adjust my Basal for exercise? When should I do it? How much should I do it by, and that's where it comes to be an individual nature of adjustment, because it takes you have to take into consideration the intensity and the duration of the planned activity. You know, if this example, you know, guy is gonna go for an hour and a half spin class, high low, it's sort of a high intensity interval sort of workout. And if he's only going in on basil, he could shut his basil down, not off, but lower his basil incrementally enough, well, before he actually starts moving, so that he shouldn't technically need much of any food at all, to continue that, let's say 90 minute spin class, for example. Yeah, adjustment to basil. Most people feel like they have an idea, I turned it off, you know, I turned it down, or I turned it off 30 minutes before, and I still went low, or I continued, I was low by the end, and then I continued to be low. The problem is that as we've talked before, circulating insulin level isn't lower or higher, until about 60 minutes post adjustment. And when you're really aiming to get into a specific target. For beginning exercise, your circulating insulin level should be low enough by that point, because this is kind of propelled intense, intense action of the insulin on a Basal level that you have now circulating. If you're normally at a 1.0 unit per hour Basal rate, and you knock it down by 50%. That 50% reduction should be started at least 90 minutes, if not two hours prior to when you jump on that spin bike.

Scott Benner 7:05
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.

Jennifer Smith, CDE 7:36
So this gentleman, you know, he should really reduce his Basal by 3pm. And he should reduce it for the intensity and the duration, at least by 50%. Again, these are kind of starting places and you'll find what adjustment works specific to you. But it's a good starting place. Now if he was just going to go for a walk for 60 minutes at a moderate pace enough to kind of bring up his heart rate a little bit but not crazy. Maybe his adjustment is a 25% Basal reduction, but it still needs to be taken back by at least 90 minutes to two hours before he takes that walk. Right?

Scott Benner 8:10
It reminds me of a number of things. One there was I forget what it was called. Gosh, there was a thing that happened in there. And I can't think of what the name of the website is. It's gone now. Manny Hernandez website that's not to diabetes. Yeah, they used to do that thing every year where they kind of challenged you to get out and do exercise, right and check your blood sugar and see where it would fall.

Jennifer Smith, CDE 8:34
So it was in November for the diabetes month diabetes Awareness. Yeah, check your blood sugar. Now walk or do something fun for 15 minutes of movement and check again,

Scott Benner 8:44
right and people would see that their blood sugars would come down. And so it's the same idea except with lower lower numbers and tighter tolerances for exercise your blood sugar is going to fall or try to fall because of this exercise. What can you do prior to that, to not to keep the fall from happening. And I think that what ends up happening is there's two false narratives. Well, there's a false narrative that and a problem that people build around exercise and I think about going to sleep too with diabetes. The false narrative is if I make my blood sugar this high, that when it drops, it won't get dangerously low correct. If you're thinking that you are completely missing the point right the point should be that your blood sugar doesn't need to drop like that. Let's find let's find a way to live where it's not dropping out of nowhere correct and so but I see how that's the fix right? Like I see how that's what occurs to people I dropped 50 points. So you know let's start 50 points high points ever want to be right because the guy stuck a pencil in his pocket and then he broke out of the bank so the pencil cause the bank robbery like just the Falls not the the falls the falls. god what am I trying to say? Like like the fall is

Jennifer Smith, CDE 9:59
it can be offset. If you think ahead about how insulin works,

Scott Benner 10:03
it doesn't have to happen. And so you shouldn't be planning to stop the fall, you should be planning for a fall to never happen to begin with.

Jennifer Smith, CDE 10:11
Correct or minimal enough that you really are not in danger because of the drop, right? I mean, exercise can even you know, even people who do plan ahead might see something like a 10 or 20 point change in blood sugar during or by the end of their exercise session. That's nothing, you know, if you're starting with a blood sugar of 110, and you drop 10 points, great, right at 100. Now, awesome. It's nothing, you know,

Scott Benner 10:39
my expectation isn't that you can set your blood sugar at 89. While you're, you know, running a marathon, it's never going to move, but there are things at play while you're running, that you don't think about the you know, the anaerobic style of exercise is trying to bring your blood sugar down, but you've changed your Basal rate, which is trying to bring bring your blood sugar up. Also, maybe you have adrenaline, which is trying to bring your blood sugar up. So even people who have that stability, they don't 100% know why they have it. Like they don't really understand all the pieces that are affecting this number moving or not moving. Right. It's interesting that the other thing that you said, that feels problematic to me, because I hear so many people, like, every time I speak to someone, I'll tell him the same thing. Look, just start Pre-Bolus Sing and your agency is gonna go down like a point. And then they inevitably say, Well, I can't really remember to do that. And I'm like, alright, well, then your blood sugar's gonna go anyway, what do you want from me, you have to Pre-Bolus Like, this is how this is what you're gonna see, this exercise thing really is no different. They're still Pre-Bolus thing, they're just Pre-Bolus thing with their pre Bazeley. But with it with a with a reverse adjustments that have a more positive adjustment. And so I wonder how many people fall into that category? When they say, Look, I know, I'm going to be at the gym at five. But how in God's name, do I think about it at 330? You know, in that situation.

Jennifer Smith, CDE 11:58
And so some of the strategies in pumps today, you know, there are alarms or reminders that you can set, you know, even in the PDM for Omnipod. You can set up alerts and reminders for things, I used to have one set up for reminding me to Pre-Bolus, so that I had enough time between that and actually starting to eat my dinner. I also had a reminder to check my blood sugar at bedtime. Not that I needed the reminder. But it was there in case I had a really hectic night. And I did forget before I like climbed into bed, right? So for things like a reminder, if you are pretty strategic about popping in your exercise every day at 5pm. Why not just set an alert or reminder in your pump to go off or even on your phone. If your pump doesn't do it or you don't want to set it there, put it in your phone and call it exercise adjustment or whatever you know. So it is that physical visual reminder. You have to turn the alert off. Oh, why did I set the alert? Oh, that's right. Exercise at five o'clock just

Scott Benner 12:58
just two days ago, someone said my child will let does not seem to be remembering to Pre-Bolus at school. And I said oh yeah, Artem was terrible at that. And she said, Well, what did you do? I said, I just set up an alarm on her phone for when I wanted her to Pre-Bolus it would go off and it would pop up and say Pre-Bolus. And then she you know, send me a text and be like, you want to do this now. And we built on that. And that was years ago. And last year. She says to me, I don't need the Pre-Bolus alarm anymore. And I said oh yeah, okay, no problem. And sure enough, like it just, it happened so many times that now it's just it's muscle, like brushing our teeth. Exactly. It's just memory. Right? Yeah. So that's, that's what you guys are gonna have to do. Whether this is about, you know, an adult for exercise a kid for exercise, or a kid playing a sport. You can't just, I mean, it sucks, right? That you can't just get up and run out the door and go do it. But it's going to take a little bit of pre planning and if your health or your you know, your you know, if that means that much to you, that's what you're gonna have to do. Like,

Jennifer Smith, CDE 13:58
I do think it helps. It's important. I mean, with that statement, you can't can't just get up and run out the door. Well, you know, what, what if you ended up sleeping in because the alarms didn't go off the right way. And you had planned to get to your kids softball tournament at 9am. And oh my gosh, it's like eight o'clock, and we're like running out the door with like, food in our hand and we're running and trying to get there. It just didn't happen to be able to plan. Well, in that instance. I mean, there are strategic management, you know, ideas. You couldn't adjust the basil, there was no way to do it. Right. So in that circumstance, then food becomes your offset to potential changes in blood sugar. You know, have you got up late to go for your normal six mile run first thing in the morning, and you always like to eat ahead of time, then the strategy may very well be okay. Maybe you don't Bolus if you're going to eat and head out the door in the next 30 to 60 minutes and you're going to take a six mile run depending on how long that takes you. You may be able to Take 25% of the recommended Bolus, you may be able to take none of the recommended Bolus. And strategically then manage blood sugar. Well, because you're feeding the activity you're feeding, to avoid a drop in blood sugar, but you're not stacking insulin into a time that it's just going to get active.

Scott Benner 15:19
It seems I'm smiling so much, because this is like the next level of thinking about all this about the manipulation of the insulin. When Arden would run off the field, like and I'd have her I know what her blood sugar was. And she if she ran off, I'd might say to her, Hey, water, you know, drink water now. And then maybe watch and then if I saw her blood sugar kind of dipping down the next time she came off the field, I'd say switch to the sports drink. And then you know, she'd switch to a sports drink. And then I'd be like, switch back the water. You know, and it only happens a couple of times, maybe it maybe never to be perfectly honest with it. She's played softball games where blood sugar's never moved, you've got her Basal, right, your prep right going in, or like you said, you ate the right things before playing. And these things are sitting nice and stable in your stomach and kind of holding, you know, holding the pressure back of of the activity, trying to make your blood sugar lower. But you can reverse engineer all of these ideas, like use food instead of like, you know, I say it here. Uh, you know, a lot. And I don't know how clear it is because it's sometimes not 100% clear in my head. But we don't we always just think about how the insulin impacts the number your blood sugar, but we never think about how food impacts the insulin or how food impacts the number. There's so many different pieces to this. It's all not just a one way street, like all these things are affecting all these different things. And if you pick the right one, it can manipulate something you never thought was manipulatable. And it is you know, and also

Jennifer Smith, CDE 16:43
understanding your variables and how they affect you maybe at certain times of the day is a piece of it as well. I mean, I can tell you from my from my management, I guess toolbox. I've figured out that my morning runs, I can get up, I can Bolus for about 40 to 50% of the normal recommended Bolus, as long as I'm heading out the door within the next 30 to 60 minutes, that partial Bolus for what I ate will help me keep my blood sugar nice and stable throughout. Now, in the afternoon, if I did that my blood sugar within 1520 minutes would take it would entirely take I would need. I just know my sensitivity at times of day. And so again, on an individual level. Some of the things you know that we're talking about there a beginning piece there where to start, if you've had no strategy whatsoever, these are places to start with what you can try to, you know, I guess implement, but you're going to find that things need to be adjusted personally for yourself. I raced a strategy knowing my like training run strategy, my race day strategy is completely different. With the adrenaline of everything getting going on a race day morning. I mean, and I'm not a competitive like Pro Runner.

Scott Benner 18:14
Not out there being like I'm gonna kill all these people here.

Jennifer Smith, CDE 18:17
four minute mile or something. No, I'm just I'm out there, but it's a race day. And so I Bolus 100% For my breakfast on a race day morning. And if I don't my blood sugar is 300 by the time I start the race.

Scott Benner 18:31
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. When 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 and 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 than 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 touched by type one has the back of people living with type one diabetes. Take for instance, their D box program touched by type one knows firsthand the intricacies of living with type one diabetes. And so their team has created a D box which is a starter kit that provides important resources and supportive materials to individuals with diabetes, they want you to thrive. The D box is completely free and available to newly diagnosed people. All you have to do is go to touched by type one.org, go to the program's tab and click on the box. While you're there, check out all the other resources and programs available at touched by type one.org. Speaking of support, touched by type one.org is available in English and Spanish. Don't forget to find them on Facebook and Instagram too. You do not want to miss what touched by type one is doing.

Jennifer Smith, CDE 21:17
If I don't my blood sugar is 300 by the time I start the race. And again, it's experience it's experience of figuring it out. It kind of goes into the difference of what type of sport or what type of athlete Are you? Are you a an aerobic exerciser? Or are you more the weight, kind of the heavy lifter kind of you know, anaerobic because those adjustments are different as well. strategy there for many of the lifters that I work with, they find a need depending on their lifting plan, they find a need to potentially Bolus to avoid a rise in blood sugar during a lifting session off at the potential rise that they see is slower with a Temp Basal increase. And again, in their standpoint, that Temp Basal increase needs to be started about an hour before they actually get to their lifting session, or it doesn't help enough and they get a major rise. So I think the biggest thing with exercise adjustment is what has happened. What have you seen? What is your problem? Right? Because if you start with the data that you've got, and you look at and you say okay, I just did this way totally didn't cut it. This did not work. Okay. Adjust Yeah, look at your data and adjust and make you know, is it a timing component isn't an amount component. What do you need to change?

Scott Benner 22:42
It's funny because I see a through line from this to correcting a low. So when you know when people when people's blood sugars get low and they they eat because they need to then this you know uncertainty just allows them to they do nothing and their blood sugars come like crashing like back up again. Right now you're you've just crashed down now you're flying back up. I say all the time. Like you'll know you're like a ninja when you're bolusing you know, after you've eaten for a low like, you know your blood sugar is going down to 40 or shaking or out of your mind. You're eating all the food. He stopped for a second go, okay. I'm okay now. I just ate 70 carbs worth of food. What do I do now? Well, the answer is I Bolus now that you know how much I don't know you figure that out. But that's what I did. I mean, I the first time I did it with my daughter, I'm like I can I'm so scared. Boom 350 blood sugar. Then next time I was like, Okay, well maybe like for half of it and half of it didn't work. And so eventually I could just I kind of eyeballed it was usually about three quarters of the carbs, like right and like when you stopped and really thought about it, you know, sure that 2025 carbs stopped the fall and got your level, the other 50 were just your body gonna eat more, eat more, eat more, eat more, right? If you could have stopped yourself after 25 or 30 carbs, you would have been okay. Right? You wouldn't need to Bolus but you know, you can't stop yourself in that situation. And so it's happening. Now you got to do the next thing that makes sense. It's all really just about I hate I hate to i feel like i oversimplify sometimes. But all we're talking about in the last 10 minutes, all you really heard was right amount of insulin at the right time. You know, which is obviously overly simplified. But that's all we're talking about. The right amount might mean and I get scared too when people hear it right amount that they that they think of on the positive or more like actually, the right amount might be less, it could be less basil, right? It could be not bolusing at all. eating a banana going out the door for a run and thinking you know, this banana is usually three units but I know if I didn't Bolus for this my blood sugar is going to going to go up about 80 points because bananas don't hit me that hard for some reason. And when I go out for a run, I fall 60 points so boom, I'm gonna eat the banana. I'm gonna go and that's countered it. Yeah, there's all different ways to get in that fight. I have a couple of notes the other well, please, you know, please,

Jennifer Smith, CDE 25:08
oh, I was gonna say kind of on this kind of on the same note there from the standpoint of not having enough time to adjust prior to, let's say, for a Basal adjustment truly Another component is you may actually have to, you may have to eat food to curb a potential drop. If you know the drop is coming, and you've only got 20 minutes before you're going to head out the door to go and exercise, you may have to have 10 or 15 grams of carb in order to stop a potential drop from happening. And that it's a, it's a hard thing to consider when you're also for the most part as an adult, especially considering exercise as a piece of like a weight management tool. Right? And if you're feeling like, Well, gosh, every time I exercise, I have to go and eat like three granola bars. That's like, what's my purpose? What's the point of this? Right, I'm exercising, but I'm not seeing any changes here? Well, again, some strategic planning can help. But if there's no ability to adjust anything ahead of time, because there's not enough time, you may actually have to quote unquote, eat something. And my my recommendation and most of the athletes that I work with, if it's that the circumstance, simplify the carbs that you're eating, that an eat peanut butter, jelly sandwich, or a pro bar that's, you know, like 300 calories, your body right, before you get started moving needs, the simplest form of carb you can get, it needs to get into the system to effect quickly and stop a potential drop. Because usually aerobic exercise drops happen within about the first 20 minutes or it gets started within about the first 20 minutes. So simpler, the carbs are one, you're not getting fat and protein calories. So you don't have this load of excess. And if you use something simple, like the sport drinks, you know, whether it's Gatorade, Powerade, vitamin water, or whatever it is, make sure it's got some carbs in it, and have about, you know, eight ounces, which is almost 15 grams of carbs. That's a simple amount your body is going to use it easily is going to help to stop an initial drop, you may need to bring it along and sip it along the way, as well. But at least it's getting used up. And it's not something that's packing away calories. I

Scott Benner 27:25
have a question. And I don't know the answer to it. So which just as an indication to you guys, and sometimes I ask questions I know the answer to just so you can hear the answer. But in this situation, I don't know the answer to this question. So your body when you work out uses up food as fuel, but that we're accustomed to putting that fruit in us and letting it be used up as a buoy for our blood sugar. So I don't know what my question is. But if I eat a banana, and I sit down, like because my blood sugar is 60 I eat a banana I sit down to expect this to bring my blood sugar back up to 130. And it does. But if I eat that same banana at 60, well, I'm doing something that's causing my body. So is are my muscles stealing the banana that I need for the sugar? Does it still go in the blood? And I use it and I get it any? Do I get both benefits? Or do I only get one

Jennifer Smith, CDE 28:11
depends where you are sort of in the exercise in early exercise, your body would get the benefit of the banana would actually bring your blood sugar up because your muscles now are resting, you've stopped you're eating the banana you haven't been exercising for very long. So it should technically bring your blood sugar up maybe not as much as if you were just sitting and not doing anything and eating the banana and not taking insulin for it. But the longer amount of time you've been moving, the more primed your muscles are to grab glucose and bring it into for for their benefit. Right because they're trying to retain they're trying to energize essentially. And this is a really hard concept. I'm glad question wise you brought it up. Because athletes, endurance athletes, especially those who are doing long distance of anything triathletes, long distance cyclists, even kids or adults who are in long term like competition on a weekend like four or five like you said, you know, Arden might be have been in softball from 8am until 5pm. That's a long day of movement of asking your muscles to do something. And most people are like, Ah, I've got my Basal dialed in. I totally I rocked it my blood sugar was nice and stable. But man, I felt like I couldn't move. My I just slogged through this whole four hour marathon and I didn't I my blood sugar was great, but I didn't feel the greatest. What's the problem? The problem is that you've been thinking about yourself as diabetes person with diabetes, right? You have to first think about yourself as an athlete. Athletes whether you have diabetes or not, you need energy of whatever source you're choosing to use, you know, even ketogenic endurance athletes use some form of fuel during long distance To maintain and be able to perform, and you know, people who aren't ketogenic, you need a carb source, and you need it put in strategically over that endurance time, so that you can fuel your muscles, you can give it what is needed, so the muscles can keep doing what you're asking them to do. Now, from a diabetes standpoint, what you're putting into fuel your muscles also has to work well with blood or peace, right? They have to kind of balance each other out. But first and foremost, as an athlete, you have to think what are my muscles need to perform the way that I want them to perform,

Scott Benner 30:36
you're doing two different, very different things. But they're both working out of the same pool of food, basically. So

Jennifer Smith, CDE 30:42
yeah, and thus with it, insulin adjustment might be very different. I mean, when I in training long distance like half marathon marathon, my training runs and the actual event, it's surprising, most people who've kind of dialed things in will find that their Basal insulin adjustment doesn't go down a lot. For my marathons, I only reduce my Basal by 10%. And this was conventional pumping, right, I only adjusted my Basal down by 10% for the duration of time of the run, because what I expected then was the rest of the basil to be able to encourage the food that I was taking into fuel along the way into my working muscle because insulin has to be there to propel some of that in the activity helps with the rest of it, it opens the doors on the muscle cells and lets the food end. So if I reduce my basil too much and fueled along the way, I had these jumps in blood sugar that I didn't need. Whereas if I just kept my basil a little bit lower, and I feel strategically, you know, every 20 minutes putting in a little bit of something along the course of time and hydration. Again, blood sugar stayed nice, but I also had energy to keep moving.

Scott Benner 31:57
I I should say that at the the other side of Arden's long tournament days. You know no problems like you just said with the blood sugars throughout the tournament into the evening, their regular bolusing at dinnertime. But around late evening, 910 o'clock going into falling asleep time, all the food was free at that point, like she could eat without insulin like yes, and by the end when she goes to sleep. I know people see like one way or the other usually Arden's eyes closed blood sugar falls person, like So if something's not right with her insulin, when she goes to sleep, her blood sugar tries to go down. And so even if you gave her a juice at midnight, and turned her basil off, that still couldn't catch a low after a full day of activity, you had to give her something to eat. That was substantial that would really stick with her in her system while she was sleeping. And even in the morning, even in the morning waking up like getting through the night, okay, and I've done it well, and I've done it poorly. And poorly would be like, you know, three juice boxes to get through the night and a banana or something like that. I would call that poorly. And I've done it well where I've gotten her through with like a you know, something at the end of the day that stuck with her overnight some tamping down with basil, stuff like that. But even that next morning, when she woke up, her blood sugars were like, terrific. They were low, you needed the be of the mind, you know, whatever the base amount of insulin was for the meal, like, you know, sometimes you're like, This is two units. And the next day you're like, oh, how come it was more like four today? Whatever the most minor amount was, but always the day after a softball tournament is all you need, her insulin needs were very low. But that was, gosh, if that didn't kick in nine hours after she got done playing and lasted probably for nine hours after that. It's really it's really.

Jennifer Smith, CDE 33:52
And that's what we call a Gary actually has coined the term don't like Homer Simpson, don't go dough is do do a delayed onset. Hypoglycemia essentially is what that is, right. And it is again, this is where visually looking and seeing, you know, it was about nine to 10 hours later that she started having a drop in insulin need and it lasted for another good, let's say 10 hours. That's experience. You looked at her data and you said over and over, this is what I see. So that's kind of where you have to go back and you have to look and see. Well gosh, after I have like a three hour run in the afternoon or you know a four hour softball tournament in the morning. I ended up being low from dinnertime all the way through the next morning. If that's the case, you can set temp adjustments down again in basil at a strategic time. So you don't end up having to do a juice box and a basil off for a certain amount of time because really there you're missing the boat, right? No, no, that was your treating now when ahead of time had the basil been adjusted down and off the tree It shouldn't have been needed or less of it,

Scott Benner 35:02
right? Yes. Yeah. No, I made sure to characterize it that way. Like, in the beginning, like, I didn't do a good job of it all. And you were just the whole evening was just like here, stay alive, eat this here, Stay Alive eat this, Hey, why don't we just, you know, shut your Basal off for a while and see if that helps. That's all 911 stuff like, that's not that's not like, Oh, I'm really doing a great job. You know, later, later, a great job was knowing that after dinner throughout the evening, she needed less basil, and that she should eat something reasonably substantial, like a little before bed, like that kind of stuff. But my gosh, the first couple times, you know, I did it once in a hotel room, where my God, it was just embarrassing. You're banging into things. You don't know where anything is. And it's dark, you know? And I'm just like, what is happening? And then, you know, her alarm goes off. She's like, we have another game. And I'm like, Yeah, that's great. Because I've been up all night, you know? And then the next day, all the parents are like, all the parents like, you look tired. I'm like, Uh huh. Yeah, you guys are all drinking all night, I was up trying to fix this blood sugar thing. Not that all parents at sporting events are drunk, but most of them are. And I'm not a drinker. So I wasn't involved to begin with. But they all were like they come down in the morning like all hungover and I they must have thought I was just like, quietly privately drinking by myself, because I looked worse than they did some days. But no, but there's just so much. So. So

Jennifer Smith, CDE 36:32
kind of on the same on the same note not to interrupt but the aftermath sometimes to of exercise can happen right after the lower needs and insulin can be for several hours after weightlifters to may have that rise during but then the impact of lifting and their muscles sort of building repairing restructuring. And the insulin sensitive sensitization that they get from working their muscles out, can have impact into, you know, for six, eight hours after where they actually need less insulin now.

Scott Benner 37:06
Yeah. I had that. I had that on my notes, like, what does muscle breakdown and rebuild, do? And what you know what to dehydration. I'm reminded about this again the other day, because I said this to a person. And it was like no one had ever said it to them their whole life. And they're like, you know, sometimes my insulin doesn't work as well. In the morning. I was like, you know, have you tried waking up and just banging down the glass of water? And they said no, why? And I said, Well, insulin doesn't get through your cells as well, if the cells are dehydrated, because then the insulin can't travel through. You know, I'm like Senate. And as I'm saying, and I'm like, God, you've never heard this before. You know, like three years with diabetes. Like I had never heard that before. It's like, I just Okay, that sounds great. I'll try that. When Arden's at school. Whenever her blood sugar gets sticky, the first thing I say to her is like, hey, drink some water. Let's see if you know, we can find a simple, you know, answer to this question. So it's kind of

Jennifer Smith, CDE 37:58
like things just move slowly through your system. It's like your blood gets when you're dehydrated, your blood gets like sludge, or like molasses in winter, essentially, it doesn't move, nothing moves through the system very well. Nutrients don't get where they're supposed to go. Everything that's traveling there is slow. Whereas when you're well hydrated, and everything is nice and plump with water, it can move fast. It's like a freely flowing river. Right? Okay,

Scott Benner 38:22
that so so I have to stay hydrated when I'm being active no matter what. But it is also helping me get a smooth baseline for what I expect out of my insulin. And then at least what I see one way or the other, I know is real. And not because I'm dehydrated, and or something. What does heat? How does heat impact blood sugars? Because, you know, people in the warm weather states always report problems with their blood sugars. As soon as the as the summer comes, but I'm wondering if you hit yourself up when you're working out too. Is that similar or no?

Jennifer Smith, CDE 39:02
Um, you know, that's a good question about the workout. I guess I never thought about it that way. It's probably pretty similar. In exercise, of course, your muscles are just uptaking glucose more efficiently. The doors are opening even with less insulin being there. They're just opening more efficiently exercises like free insulin, really. I mean, unfortunately, we can't live on exercise. We still have to use insulin, but it does help. But in the in the case of overall warmth. If you think about when you're warm, your vessels move closer to the surface of the skin or right and you sweat and you that's a cooling effect, right. It's your body's sort of ways so that you're you don't overheat. Well, when that happens, get more circulating. You get more circulation around the actual insulin pump. or injected sight. So you allow that insulin to get absorbed faster, I guess is the easiest, most simple way to say it. So in warm weather or when warm weather comes, many people do see, in fact, a friend of mine, once April hits, she's always like, my Basal just need to go down, it's warmer outside, I know that I need an adjustment, nothing else has changed, my weight hasn't changed my infant, my food hasn't changed, I am just outside more, it's warmer, she needs less insulin, and then it might go up again in fall and or winter. And exercise, obviously that heats you, you get a lot faster circulation, I mean, that's the benefit to your heart, your you know, circulatory system is exercise does your heart good, makes it pump harder. So with that, and the fact that you're getting warmer, you just get a faster circulation of insulin essentially.

Scott Benner 40:53
And we haven't really said this here either, but you have type one diabetes, or the person we're talking about does exercise is very important to you. So this is a piece you have to figure out, you can't just say, I can't figure out exercise you you need exercise, you know, everyone does, but you know, people with diabetes needed maybe a little extra because you're trying to keep your body healthy. While it's trying to while it's trying to, you know, it's trying to beat you up, you need to you need to take away as much power from that as you possibly can.

Jennifer Smith, CDE 41:22
And as a weight management strategy, sort of in the same realm of it needs to be something that happens everyday and many people with diabetes are really struggling and really trying to keep a healthy weight. If you can strategically plan your exercise in the aftermath of a meal. As I said before, you could potentially use less insulin then because you're planning the exercise in a timeframe of after insulin has been injected, insulin is going to work better, you're also going to enable your body to burn more of that fuel off. Right, right. So it's a good strategy to just all

Scott Benner 42:01
around eat and then workout,

Jennifer Smith, CDE 42:05
eat and then workout. Again, ability to reduce the amount of insulin again, prevention of lows, but also just burning calories and not having to take as much insulin

Scott Benner 42:16
doing what you what you wanted to what you what you intended to do. When you when you decided to get up and go exercise. I want to look real very quickly to because Chris Rutan was on the podcast and we talked a lot about we talked a lot about this kind of stuff, too. And I just want to be able to tell people what episode that was. Be nice if I could figure it out. I am the guy with the podcast you would think I would know but

Jennifer Smith, CDE 42:47
Well, there are so many of them. Well,

Scott Benner 42:48
that we are getting to that spot, aren't we? I can't figure out what should people are like what episode on my I don't know anymore. Let's see where's all right, I'll have to figure it out and plug it in. Jenny's got her own life. She's got to get back though. I will figure it out. And you'll hear it edited. And right here. Chris Rutan was on episode 201. Jenny, is there any anything else that you think we should talk about here?

Jennifer Smith, CDE 43:11
We could probably go on and on with more like advanced stuff. But overall, I think those are the good basics to start with.

Scott Benner 43:19
Yeah, I think this is what we're looking for basic. And we'll we'll hit more advanced things in another episode. Let this all set. Cool. All right. Well, thank you very much. Thank you. 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 G voc glucagon.com. Ford slash juicebox. you spell that GVOKEGLUC AG o n.com Ford slash juicebox. If you're living with diabetes, where are 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 or 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 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 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 this 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. 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 on 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.