#231 Diabetes Pro Tip: Variables

Diabetes Pro Tip: Variables……

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 0:00
Hello, and welcome to the next episode of my diabetes pro tip series with CDE Jenny Smith. This one's called diabetes pro tip variables. The episode is sponsored by Dexcom real good foods and dancing for diabetes, you can go to dexcom.com forward slash juicebox real good foods calm and use the offer code juice box to save 20% of your entire order or dancing the number for diabetes.com. To find out more. There are also links in the show notes of your podcast player, and at Juicebox podcast.com. In this installment of the diabetes pro tip series with Jenny Smith, Jenny and I are going to be talking about variables those things that you know, change, but impact your blood sugar. The stuff you don't always think about, like are you taking a medication? Is it allergy season? Has it gotten warmer outside or colder outside? Do you have road rage? Stick around Jenny and I are going to talk about it all. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before becoming bold with insulin or making any changes to your medical plan. Can I take a second to share something with you that I believe you have an incredible impact on. I'm talking about the popularity of this podcast. I'm looking right now at the total downloads for April of 2018. Versus April 2019. Back in April of 2018, I was incredibly impressed with how many people were listening to the show. And last month, three and a half times more downloads than the previous year. And as I'm editing this, and getting ready to put this up for you in May, I'm pretty confident that this month will be the most popular ever.

Easily surpassing April of this year, which as I said, is three and a half times more popular than April of 2018. So as we approach the 1 million downloads of the Juicebox Podcast, I have a small favor to ask of you that I really have no right to ask because you're already listening. And I love that. But could you just do me a tiniest favor, find one person who doesn't listen right now who's not a subscriber, a person that you believe would enjoy the show and introduce it to them, show them how to download a podcast app on their phone. Show them how to subscribe. And perhaps you know, just share with them a couple of your favorite episodes to get them started. My goal, of course is to limit the struggles and suffering of other people. You guys know how it felt before you found the show. I'd like it if you could help somebody else to get to where you are now. And with all the ads the asks and the excitement of the 1 million downloads out of the way. I think we should start the show. Hey, everybody, this is Jenny from integrated diabetes services. I understand a lot of you have been contacting me privately, which I think is a fantastic idea for any and all of you who are interested. Jenny, of course, has been doing the diabetes pro tip series with me. This was supposed to be the last episode. But I think unless Jenny has changed her mind, we are going to continue to add to this series throughout the year. Yeah, excellent. Jenny. I'm very excited about that. And today's topic is. So you guys don't really understand how all this happened. I wrote down what I thought were the tenants of the podcast. And I sent them to Jenny. And she put them in a different order and made changes to them. And she's like, I think this is how that this will work. And I was like that's great. And then we were supposed to Oh, well. You know what I was thinking Jenny's? We were supposed to record basically a like a menstruation episode but i think i but i think it fits really well into your idea for today, which is variable. So I think we're going to combine the two of them if that makes sense. You agreed? Excellent. Okay. Why don't you tell people what made you reach to me and, and suggest this

Jennifer Smith, CDE 4:05
the word variable brings in the whole topic of discussion, right? I mean, we're taught from the get go there are three main factors that really you know, you get educated about is impact on your overall blood sugar control. We've got an I kind of call them like the triangle of management of what you're told about to look for effects. Exercise, the medicine, you take and type one of course insulin Sometimes though, with the changes in some of the medicine now for type one use could be other medicines. And then you know, the third one is food. So you got exercise, medicine and food and you know, if you contain all of those, you're going to have diabetes success, right? If you just learned about all those little pieces when they're only three, so you're going to do awesome. Well, that's like baloney.

Scott Benner 4:57
I think there's so many more factors. To consider so many more variables or like icebergs, right? That can kind of come through the course of your day. I mean, some of them, you can sort of head off, you may know that they're coming if you know, to look for them, and that they could have impact on blood sugar. Again, the short list that I kind of came up with just to talk about today, cuz I know, we don't have like, four hours to discuss everything, I think I came up with, like 10 or 12, you know, variables that I could really think, affect most people, and that you really should consider. So, you know, I'm sure that you probably have some variables that you know, just with what you've seen with your own daughter's management, right? Absolutely. And, and to kind of tag on to what you were saying, I found myself this past Saturday at the dancing for diabetes touched by type one event standing in front of people telling them that insulin timing is the seed of the tree, that is your management. And as long as you know, we can always go back to that as the base is the root, right? But then eventually, you know, that seed grows a trunk and the trunk grows, branches, and the branches, grow leaves. And all of these different parts of the tree can affect your blood sugar and will sometimes, but you can't get caught in a problem. And staring at the leaf on the 77th branch and wondering what is that leaf doing to me right now, even though it is doing something to you, it's I like to look back afterwards and say what happened there and try to figure it out. But in the moment, as we say, here on the podcast in the moment, it just means you need, you know, you need to change, yeah, adjust, right, maybe that means more insulin maybe means less. The idea that bazel insulin is insulin too, and we always forget about it, everyone wants to set their bazel. And then think about Bolus, which just doesn't work, you know, you have to think about the timing of all of the insulin. And when one of these bazillions of variables comes into play, some of them being more constant in your life than others. They have requirements. And they require of you to, to resist, right? Like you can't just, you can't walk through a day when you're premenstrual maybe the same way you walk through a day when you're not. Oh, right. And so go ahead. Give me your first one. What's your first good one off your list?

Jennifer Smith, CDE 7:22
Cool. My first good one actually takes into account the three that I mentioned, right? exercise, medicine, and food. Each of those seems like a simple like one topic blurb word, right? It's if I figure out the medicine, but you brought in a good factor, it's the dosing the timing, the consideration of the medication itself. And again, with more medication being added to the list of potential use, especially with type one, you bring in more variable there. And so with the dosing and the timing, it takes evaluation, so that that variable can be I guess, better known for you. Again, you know, we all have your diabetes may vary, right? We all have our n of one life with our insulin that we use, and we learn how to dose it, learn how to time it. So that's, you know, one and then the other two, exercise has a lot of variables to it, you get the blanket statement from a doctor who says, just take your pump off or just, you know, do a zero bazel if you're gonna go and exercise. The world of exercise is not that simple with diabetes, but if anything, there are a million variables within just the topic of exercise if you consider you know, slow movement, like when I take my dog out for a 20 minute walk and he stops me pees in sniffs everything. My blood sugar could drop 50 points from just a dog sniffing walk.

Scott Benner 8:50
sniffing walk not to be confused with the brisk walk

Jennifer Smith, CDE 8:53
with a brisk walk. Exactly. So I mean, you know, things like that are all you know, going to like Disney World to walk around all day, that slow, consistent movement, you wouldn't count as exercise not like going to the gym and huffing and puffing and sweating to death. But it's a variable that in my experience, I've found I need to reduce my Basal about 20% for the full extent of the time that I expect to be at like a Disney park or someplace similar.

Scott Benner 9:23
Can I ask you a question about that? Yeah, we always say that and then we never sort of not not you and I just people in general, we always say like, you know, exercise can bring my blood sugar down. In I don't want to go too deep into it. But why? My question is, when my body starts moving, what does it do that makes my blood sugar fall? Is it using the insulin more effectively? Is it speeding up the like, that's what I want to understand real quick. Those of you looking for a diabetes organization to support should check out dancing for diabetes. That's it, no big sell. I just think you should Dancing for diabetes.com that dancing the number four diabetes.com. I was at their event, a couple of weekends ago, I heard Elizabeth talk about how she started the organization. Her words just made me so proud to be there and to be supporting what she was doing. And I think you would feel the same. Just check them out dancing for diabetes.com. That's dancing the number four diabetes.com.

Jennifer Smith, CDE 10:25
Yeah, so the exercise piece, if you consider I like to refer to it exercises like free insulin, really, it's some types of exercise again, you know, the low slow to moderate intense exercise, you really looking those cells, doors on them have, you know, little locks, right, for the most part, we used to use insulin to unlock the door to get the glucose to enter. When we exercise, the body is sensitized to insulin, and those doors open freely, because your body wants to incorporate the glucose into the cells to get used and to energize the body to keep performing. So if you've got and this comes into the first, you know, topic of medication and the timing, when you're looking at exercise, the timing of insulin is very, very important. And the dose and what you're coming into that x active phase with onboard, that's just it's huge. You know, so if you're looking at going into a five mile slow Temple Run with five units of insulin on board from the Bolus that you just took, think again,

Scott Benner 11:37
sizing, I just spoke to an adult woman this weekend, who still play soccer, and she said, you know, the advice she got from her doctor was to take her pump off, and she said, but then my blood sugar goes sky high, and I can't play. And I don't want to do that. And I didn't have much time to talk to her. But what I said was, I said in a very basic way, that everything I say on the podcast, works for activity, you have to wrap your brain around it. But in the end, if you're using the right amount of insulin at the right time and taking into account that this exercise is going to happen, that's it. And it's simple to say, well, you just turn your basal back an hour before and during or something like that. And that may be the answer in there. But there's an answer in there. And that is you have insulin needs. During the soccer game, you have less insulin needs. So don't give yourself the dog sniffing insulin when you're playing soccer.

Jennifer Smith, CDE 12:32
Right. Exactly, exactly. So yeah. And then you know, so then we, you know, take into consideration the adjustment for exercise, but there is also exercise on the opposite side that may require more insulin. Yes, because of adrenaline seems like you know, those who lift or do a lot of resistance training, or do HIIT workouts, you know, the high intensity interval training, where you've got a little cardio but these really like short bursts of intense exercise in some of my first, I guess, personal informative about intense burst exercise for my blood sugar control was when I was starting to train for my first half Ironman and my training routine had some of the running as sprint Hill sprints, where I'd literally like fly up the hill and then sort of jog back down and fly up the hill. Well, you know, I adjusted assuming that I'd have the similar responses other exercise where I would adjust the insulin and whatever, man I was high. I was like, you know, but adrenaline, you know, research adrenaline is kind of a component there to consider. The weightlifters that I work with, tend to find that they need to dose insulin before a heavy lifting session, they might need to take a unit of bolus insulin, they may need to do a temporary bazel increase those kinds of things. So exercise isn't as simple take your pump off and go and exercise. That's not it.

Scott Benner 13:54
That's the do. No, that's do not die advice. That's advice that won't kill you. It's definitely not going to help you. Right, right. Exactly. And the example that I use over and over again, in my talks in here is the idea of Arden showing up for basketball at a great blood sugar and then running around which makes you think blood sugar would fall but then would go up. And then we figured out that she was competitive and she wanted to win the basketball game. So her gitelman spiked up

Jennifer Smith, CDE 14:22
and difference there you probably found from her game to her practices. Yes. Which is very common for any athlete who is in a competitive anything. I mean, I found that with my running races, I could go out for my nice runs and for my training and have great management knew what I was doing some of my first five K's man, I was astounded at the rise in blood sugar as soon as I got in the car to head out. Yeah,

it was like a drift off. It was like

Scott Benner 14:53
play competitive sports or have been around it this this might make sense to you. My son always echoes this back to me that it's true. He said, it's kind of impossible. They always tell you to practice like you play. And he said, it's kind of impossible to do. Because when you're practicing, the game's not there. Like, right like there's these the same intensity is not there the same desire is not there. You can't You can't duplicate the feeling a feeling like you're going to lose, or let someone down or lose your spot on the field or some something like that is like you can't you can't make that up in your head while you're practicing. No. So your your insulin needs will be different because your brain is thinking differently about what you're doing. Wrong. It's very interesting.

Jennifer Smith, CDE 15:37
Yeah, yeah. So those are, you know, all even the time of day for exercise could make a very big difference for how you strategize adjustment. I know my morning adjustment for exercise is very different than my mid to late afternoon or evening exercise. Very different just based on again, the sensitivity and all of that kind of stuff.

Scott Benner 15:56
So, and Arden, as an example, closes her eyes to go to sleep and her blood sugar goes down. It happens almost instantaneously. So it's not a huge job. But that girl goes to sleep and the I don't know what you would call it the day life. Right? The anxiety and knowing like a release of Yeah, she relaxes. And when she relaxes, her body's not forcing her blood sugar up in the same way. And it starts to drift down. Yeah. Wow. Okay. Jenny, let's on that list. Now.

Jennifer Smith, CDE 16:27
The next one, again, of the three, the third one was the food, right? And we think okay, and we talked about this in one of our other, you know, just master carb counting and you've got it like figured out you've got it totally nailed, you'll be clear and beautiful post meal blood sugars, right? Well, again, I kind of Kanan takes into consideration, type, amount, combination of food, what went into the meal, if you sit down and you eat, like, you know, a three cup jar of peanut, versus a three cup plate of white rice. carbs are there in both pictures. The coverage of them, however, is very different. So those variables that kind of come in with food, we know now, thankfully, in the past, I would say five D, maybe even 10 years, we've become much more aware. and educating people a little bit better about it's not just carbs, it is the fat it is the potential protein. And with some of the I say newer, they're not technically new, they just have gotten a lot more media is things like the Paleo kind of diet or the keto diet, those kinds of path plans or you know, eating habits, they require you to figure out the impact of the food in a different way than just carbohydrate.

Scott Benner 17:49
I know I think I've said here before, but I was with a person eating no carb at a meal. And we went into a restaurant sat down, hi, Vicki, Vicki ate food. I feel like we sat there for a half an hour and talked, we got in the car, we're driving away, and she pulled out her PDM for her ami pod and gave herself insulin. And I was like, what was F word she goes, the protein is gonna hit me. So that's it, that's it. I don't think she ate one carb while we were where we were. So different ways to wrap your head around different things. And I have it, you know, again, I just this is fresh in my head because I just got back from a talk. But there's a slide that goes up that says all carbs are not created equal. But you have to you have to write you have to believe that 10 unit, you know, 10 units away, I cannot talk about grams, 10 grams of rice and 10 grams of watermelon or grapes are not going to impact you in the same way or for the same amount of time. Okay, if you don't know that, then you'll struggle. You know, you can't just you can't just count your cars, put your insulin and eat your food and go away. If it worked like that. Well, then you're and this probably would need this podcast

Jennifer Smith, CDE 19:03
would be perfect for all that's exactly right. Well, and then the other factors, you know, that will kind of, I'll touch on as we sort of go on here. But factors of food impact, you may get many of your common things figured out as I think I said in one of the previous ones, you know, if you figure out the 2025 most common foods, meals, things that you eat, that's like 80% of your management, if you kind of nail those, figure them out from the protein, carb fat impact, awesome. But then we bring in all of these other potential variables, like you mentioned, initially, you know, the menstrual cycle for women. Well, you may have all those wonderful things figured out and then in comes the three to seven days before your period is supposed to start. And if you haven't been told that there is an impact on blood sugar, and you just think that gosh, it must be my insulin or it's a bad site or something crazy is going on, you get really annoyed and confused. And for women, that could happen every single month that you're getting annoyed and confused. And unless you start to track things,

Scott Benner 20:12
you'll remain annoyed and convenient. I try so hard to tell people, I don't want you too. I don't want you to completely forget about the possibility that your insulin went bad, or that your infusion site suddenly stopped working. But if your blood sugar was at all day, and then all of a sudden it jumps to 150. And it won't move. It's probably not your insulin, you know, but you see so many people, they hyper focus on the physical things, they think they can see that they that they can they can believe might be the reason, right? And I you have to be able to kind of look back a little bit and say, okay, it doesn't make any sense that my blood sugar was doing what I expected it to do. Suddenly didn't, why am I thinking of the pumps at fault? Like why am I thinking the insolence of fault that insulin has been working for a day and a half, you know, or that vials been working for two weeks, or whatever it ends up being? You really sometimes just have to think it's probably the stuff I can't see. And then I think and then I always think too, and then don't spend too much time on it. Bring it down, drop it. Yeah. And here's a great variable, say your candle is loose and you're leaking. And you're not getting as much insulin as you believe when you push the button. Still, in the end? The answer is, you're not getting enough insulin. The reason is mechanical. But the idea is still the same. If you were getting insulin, your blood sugar wouldn't be that high.

Jennifer Smith, CDE 21:38
Correct? Absolutely. And when we take into consideration, you know, cycle changes, if you start to track things as a woman, and you do have a cycle, and you're not on birth control that completely, you know, cuts your site off entirely, and you just don't have it anymore. If you're having a cycle, start to track things, because that's a good way to figure out some of that variability that a woman will have has nothing to do with the male at all diabetes management strategy. So if you're a woman listening, and you're within the time period of potentially having a cycle, and you're not postmenopausal, or anything, start to track your cycles and evaluate, usually, for most people, they see a rise prior to their cycles starting, as soon as their cycle starts usually needs dip back down, up until about oscillation for women can be anywhere between day 11. And day, like 18, give or take. That could be another rise in hormones, it's usually shorter, it's only about two or three days. And then things kind of drift back down again, typically before that three to, let's say, five days before your period starts again.

Scott Benner 22:49
So we have this continual roller coaster of hormones through the course of a month. And if nobody's kind of clued you in to pay attention to it, you may just feel like there are variables that you just don't know what's happening. It just seems random if you don't think I'm not aware that that's an impact. And they're, by the way, they're fantastic. I happen to know, trackers like different apps you can get for your phone to track your period with it's it was only a period tracker, there you go. And it was only uncomfortable for me like the third time I asked her Can I see the app that tracks your period real quick. You know, she said she was like, Okay, take it. But it really is spectacular. And in the end again, you need more insulin, you need less insulin, you need the regular amount of insulin, you know, once you recognize that it's happening, and you don't spend a day and a half wringing your hands wondering what's going on and you just stay fluid and do what it asks, then then then it's not a burden anymore. It's just I need more insulin, but our brains get stuck. You know, you and I talked about this before we started recording. But Arden's looping now and I'm seeing with her bazel, that how much more basal insulin the loop can use. And I thought back to when I used you know, I had ardens bazel, before the loop set up at like 1.4 an hour and to double it to 2.8 to me seemed like all the insulin in the world. And now I'm seeing the loop do it too, sometimes four or five, six units, and not for a full hour. But it's still it's I realized I was stuck in the number the idea of the number and that can happen to you too when your period pushes up your insulin needs. And you think that's crazy. Let you know on most days, I use 20 units all day between Basal and Bolus 40 is going to kill me. Well, it's not that day because your needs are different.

Jennifer Smith, CDE 24:35
She needed it. Right. Right. Absolutely. Absolutely. And that I think you bring into, you know, you lightly touched on, like the site or the pump or you know, those as being variables, but they certainly are. I mean, you have to know when to definitely address it as a potential site issue. You know, if you're in the time period of, let's say, your mom or your man and you shouldn't have hormone issues and you've got you been floating along beautiful for, you know, weeks and weeks and weeks. And now all of a sudden you've got this like, high blood sugar, you know, you're usually up to like 140, maybe after your breakfast, and now you're at like, 300. Clearly, that's not normal if another variable isn't there, right? So, you know, you address things you say I'm Hi, let's address the Hi, but why is it happening as well? Could it be the site, check your site? You know, those kinds of things? Could it be the insulin think about, you know, if it's brand new vial, probably not. But if it's a vial that's getting close to that, like, end of life, like it's almost empty, or you've, you know, you don't use very much insulin, so you're getting to kind of that 30 ish days, especially this time of the year and through like fall, where if you keep your open vial of insulin out of the refrigerator, temperature changes will affect insulin. So it's really an important piece to consider, maybe you just need to change the insulin out. So those as you know, potential site issues, the other site issues would be the site itself. Have you used this site over and over and over and over? And finally, it's gotten to the point of just you can't use me anymore?

Scott Benner 26:13
Why would you switch to a new site expected it's possible that you need lesson so and then you needed prior on the old practice? Maybe that sites working better? Correct. And for all my talk about don't beat yourself up about it's probably the pump it's probably the pump once you decide it's your it's your site, it's you know, it's the pump. And nobody bails on a pump site faster than me once I believe it's the site, you know, I'm like, okay, off gone. And that's that, you know, and you if you're newer to this, by the way, this all seems I try to bring this up on small talking about things on the podcast is an exploded view, right? Like you're really stretching things out to see in your regular life. It's not going to take the last five minutes a Jenny and I talked about this for you to make that decision. You know, you've heard me say before, like about cgms. People, like how do you know how you can trust your CGM? Like you can tell. They're like, What do you mean? Like sometimes it's 30 points off, which by the way, you know, 30 points off a 10 year old meter. I don't know why we're believed in the meter before we believe in the CGM, but neither here nor there. My point is, is that if you have some experience with this for a while, you know what's real, and what's a ghost, you know, and you can, you can look and say to yourself, alright, this is clearly the site, this is going, you can look at your CGM and say, I don't think it's possible. My blood sugar has been at three for six hours, maybe I ought to use my meter to see if that's right. And those decisions become very easy over time. You may be thinking, but Scott, you just got done saying that diabetes technology is not perfect all the time. Why would you put the ad for Dexcom? Right here? Are you aloka? No, I'm not crazy. I'm confident. And I love the Dexcom g six continuous glucose monitor. It is of course, at the very core of all of the good decisions that we're able to make moment to moment, day to day, week to week, year to year, we're helping my daughter live well with Type One Diabetes, nothing is perfect. But Dexcom is as close to perfect as you can currently get. The only thing that's ever going to be more perfect. Then Dexcom g six is whatever the next version of Dexcom is. I mean, that's my guess. Here's what you need to do. dexcom.com forward slash juicebox that's how you get started. You want the Dexcom because of its predictive nature, because it can tell you not just what direction your blood sugar is moving in sure it's going up. Yeah, of course it's going down. But how fast is that happening? Am I falling so quickly that I need you know, an emergency infusion of juice or some sort of a carb? Or is it just kind of drifting down? Am I maybe able to watch it for a second see what's gonna happen? Is my blood sugar jumping up right after a meal? Maybe I didn't, you know, use an offense on the things that you're wondering while your blood sugar is doing what it's doing the next context the Wonder out, it shows you it replaces wondering with wonder, like wonder like, you know, fireworks like whoo like that. Our results are ours and yours Of course may vary but my daughter's a one C has been between 5.2 and 6.2 for over five years, largely because of the information that we get back from her Dexcom g six, go to dexcom.com Ford slash juice box to get started today.

Jennifer Smith, CDE 29:30
You know another one that

is this time of the year in consideration of like insulin and viability and all that stuff. Another one that a lot of people don't realize is this time of the year of could for many people bring in the variable of allergy.

Scott Benner 29:48
Okay, how would so right just because because that's almost an infection

Jennifer Smith, CDE 29:54
causing yeah causes kind of like that histamine reaction in the body which causes an inflammatory respond, you know, that's the reason you get all Flemmi. And you know, bleary eyed and like whatever is coming out of you desperately to push out

Scott Benner 30:07
the dust

Jennifer Smith, CDE 30:08
push out the nastiness, right, exactly. I mean, unfortunately, my husband has nasty allergies in this time of the year. He's just like full of sneezing and like runny eyes, and you know, that kind of stuff and it stinks. But when you consider diabetes, insulin needs with this as a stressor on the body, we talk about stress as a variable to allergies could be a stress variable. And so your insulin needs may very well go up in this time of the year. Because of that type of, you know, setting now, if you use some medications to help deal with the allergies, it's always important as a medication kind of component or variable, check the label, or ask the doctor, make sure any of those medications that you may take for, you know, an allergy won't necessarily have impact on blood sugar, some of them have a steroid base to them. And steroids, as we know, will usually raise blood sugars as well. So you could have kind of double impact and medication impacting as well as the allergy itself impacting Do you have pain on your list? plan would be another stressor within that like, kind of body sort of? Yeah, absolutely.

Scott Benner 31:21
People don't think about but I've seen it happen so many times that you can't not trust I saw Arden get hit in the knee with a softball once. And her blood sugar immediately started going up and stayed up. State her insulin needs remained high for days while the pain in her knee subsided. It was a significant pain. Yeah. And so let me ask you if I have a headache, would that push up my blood sugar?

Jennifer Smith, CDE 31:45
It could if it's a if it's a bad enough headache, especially those who may have like migraine issues absolutely could be a variable. Sometimes too, you know with that as as effect. Sometimes if you notice the rise in blood sugar, you take medication to offset the pain itself. If the pain isn't felt anymore, blood sugar's should or could very well come down. And so you do have to be kind of cautious with the adjustment in insulin. If you're doing something to cover the pain, you may find that correcting the high blood sugar drives it down more than you expected, because you're not feeling the pain anymore. So

Scott Benner 32:23
funny. My next question was going to be to say I'm in a road rage situation. And because I'm all dialed into my diabetes, and I've got a dexcom I see my blood sugar goes from 80 to 140. I don't want a bolus right away, right? Because my bazel because that that burst of adrenaline is going to go away quickly. And then my base, my Basal is going to crush that number again, most likely,

Jennifer Smith, CDE 32:45
most likely, I mean, Basal never meant to essentially bring blood sugar down. But once the stressor is gone like that a quick impact kind of thing. Typically, your blood sugar should start kind of coming back down. And if it doesn't, it just means obviously that you are thinking about it and continuing to like dwell on the problems right? You have extra road rage

Scott Benner 33:05
is when

Jennifer Smith, CDE 33:06
you have extra road rage Exactly. Go home and you tell every neighbor about what happened on the way home and you know, you continue to perpetuate the issue. Bolus Ford

Exactly. Yes, exactly

Scott Benner 33:18
is a quick burst of adrenaline the same as a lollipop. In that it is it does hit you but that it can't sustain the rise. Is that a similar idea?

Jennifer Smith, CDE 33:29
kind of similar idea. It's kind of a good way to

Scott Benner 33:32
know something, you know, doctors used to and I I'm sort of against the idea of talking about free foods. I don't I don't really think there's free foods in general. But But I have seen it with Arden and I've always wondered, is the fact that like she put a lollipop in her mouth and her blood sugar went up a little bit and came down is that because a lollipop is a quick hit that goes away? Is it a free food? Or is it because I've got the balance over insulin so wrong that it's able to handle carbs? I haven't like haste to think about that when she was younger. Like Am I really like did that really not have an impact or like, you know how we talked about if you know, I was explaining to people this week and I said look you have to Pre-Bolus you can't be scared of it like insulin works the way it works. It does not work the minute you put it into your body if you Pre-Bolus and two minutes later your blood sugar starts falling the Pre-Bolus did not magically start working you probably

Jennifer Smith, CDE 34:25
were falling already

Scott Benner 34:27
yes you were falling already or you did something hours ago that is impacting now that you're unaware of. And I always wondered about that like when we'd give our like little bits of candy my jet was I just premature like what I just holding up a low that was coming anyway.

Jennifer Smith, CDE 34:42
Could be the factor and that's also a kind of brings up a good point while it's not really a variable but it might be if you consider it. Lows when you treat a low we recommend treating with simple sugar, right? When you treat with simple sugar, that simple sugar is really, its potential impact lasts an hour to 90 minutes. And thus the age old recommendation, if you have a low blood sugar, treat it, it comes back up if you're not going to be eating a meal or a snack within the next two hours, treat or follow up that carb sugar with a snack that includes protein. And the reason was to sustain the blood sugar than because that quick glucose like you just said, it goes in it does its job, it gets things up, but eventually the bazel it's there that's supposed to be right. That's sugar, it will overpower it. There's not enough laughs really, if it's working the way it's supposed to. So yeah, absolutely adrenaline and a lollipop.

Scott Benner 35:46
So the numbers not really the power without the way it's just a simple sugar, you have to give it a protein or a fat to actually add the, the weight to that number that

Jennifer Smith, CDE 35:59
so that knowing something slower digesting you know, if you consider something like you know, keen raw or like a piece of sprouted grain bread or you know, something longer sustaining. It's got the carbs, probably more than the lollipop does. But you're going to get the rise it's going to be a lot slower, but it's also going to be a lot more sustained.

Scott Benner 36:17
Jenny, you're not from where you live. Are you? Like were you born where you live? Like Jenny's? Like I'm from the Midwest. And still, I'm still you said qinhuai as an example of that was really interesting. Oh, by surprise, I was like, Oh, we get fancy Jenny must have been burned somewhere else that moves where she lives.

Jennifer Smith, CDE 36:39
Oh, no, not at all. I'm just you know, I am a dietitian. Oh,

Scott Benner 36:43
okay. See?

Jennifer Smith, CDE 36:44
all the fancy foods I guess I

Scott Benner 36:46
should know about right. I haven't I haven't read your bio in a while. I don't worry. I just I usually do it before the episodes when I'm putting the episodes together. You can well I got me by surprise. If this was a regular episode. I would totally title this episode. Keane was just so you know.

Jennifer Smith, CDE 37:02
Funny,

Scott Benner 37:03
so many people. So many people came up to me this weekend and said, Can you put any more effort into making the titles match what the episodes are about that is like No, probably not just listen, you'll figure

Jennifer Smith, CDE 37:13
you can title it the variable of keywords that

Scott Benner 37:20
attract what's next on your list.

Jennifer Smith, CDE 37:22
The weather. As we consider temperature changes, I've got you so many people in I noticed myself I've got really good friend who notices as soon as March hits. And you know, here in the Midwest, March may or may not be warmer than the winter has been. But she's like, as soon as Marcus, it's like a switch in her body goes off. And it's like, it's spring, hey, let's dial down the insulin needs. And she literally has about a 20% decrease in her basal needs, from March all the way through, like, you know, October ish, when it starts getting a little bit cooler out, then across the board rule. For the most part, the warmer the weather, the more and the more time you might spend in the actual warm of the warm weather. You know what, what is warm weather do it increases the like, your body needs to cool itself off. And so your vessels come closer to the surface of the skin. So you can cool yourself by sweating a little bit more that like increase in in the vascular nature of the underlying tissue brings vessels closer to insulin, and you absorb faster.

Scott Benner 38:31
Plus and this isn't physical but physical in terms of inside of your body. But you probably become more active when it gets warmer to

Jennifer Smith, CDE 38:38
right. Absolutely do more things. I know myself I you know here and my husband talks about it all the time. He hates the winter weather and everything and he's like, let's just move someplace much warmer all the time. So we can always be outside. And quite honestly, if that was the case, I probably would have lower insulin needs throughout the whole year because warm weather comes I'm consistently at the park with my boys or and go and doing my normal exercise. I mean, I don't even consider that exercise that's just part of our normal daily when it's nice outside. So yes, we become more active.

Scott Benner 39:12
When it's nice enough to be active more often outside. I think what Jenny's saying is if you're thinking of relocating to a warmer place, and you feel like you can't afford it, don't forget to deduct your savings and so on. Right, there you go. You might be able to afford more rent because of a go. All the diabetics are gonna live in California now.

Jennifer Smith, CDE 39:33
Right, right. And the opposite of that, you know, the cold weather, you need to stay inside more oftentimes, cold weather means you're eating a little bit harder your food, you know, to kind of sustain and back up or kind of plump up almost. You eat more like stews and things that might be a little bit more protein and fat Laden, just heavier meals in general. I mean, nobody eats well, maybe some people do but nobody eats like a rockin hot. chili, dinner in the middle of July summer. at certain times, no,

Scott Benner 40:05
I get that you're more sedentary in the in the winter anymore

Jennifer Smith, CDE 40:08
more sedentary. Exactly. You may get your exercise, but it may be shorter, you know the, though it's not as light outside anymore in the wintertime. So all of those kinds of things as far as the time of the year allergies, whether cold, warm, they can all be a variable. So I have a variable for you. Is it possible? It's more of a question that you may be able to tell me to shut up? But

Scott Benner 40:33
do some of our bodies react differently to Calculus than others? Like Like this? Might this gives a possible that? Because you're because that candle goes in? Right? It's seen as a foreign body immediately. Do some people see a third day on an insulin pump less effective, but some people can make it longer or shorter? But yeah, okay.

Jennifer Smith, CDE 40:56
Yes, absolutely. And I think that's part of the reason, you know, Omni pod, especially did their 72 hour or up to 80 hours of, you know, exploration, essentially three days on the pod, because the studies have actually shown that longer than three days with a site inserts to impact the absorption at the site. So if you think of the consistent drip, drip, drip, drip, drip, and then these big boluses, I mean, if you don't use a lot of insulin might be two units. For every Bolus, if you are some of the team guys that I work with who are eating, you know, 100 plus grams of carb per meal, and the ratio is a one to three, you've got huge 20 unit bolus going into a site and that site gets, it gets saturated, it can only absorb for so long. So some of it may not necessarily be canula. Some of it may be how long and how much is going in at the site. For the people that are sensitive to different candles, though. It could be the angle, some people do much, much better with the angled type of canula. Other people do much better with the 90 degree canula. I myself found no issue with Omni pod at all. I mean, I was a long time user before I started looping about a year and a half ago. But once I started looping with my Medtronic pump, I actually found the angle candles were horrible for my skin, they did not work. And I found the 90 degree plastic canula also wasn't something that my system seemed to really like. Whereas the steel canula that goes in in a 90 degree angle. It's kind of like a foam tap. You just pop it right in. That's awesome. It is like my go to set now. It's fabulous.

Scott Benner 42:38
Just t slim have steel and plastic. They do. Yeah, I see people a lot talk about the people who struggle on the T slim move to the steel Canyon that sometimes helps.

Jennifer Smith, CDE 42:52
Yep, the one for t slim is called True steel. And the one for Medtronic is called the shorty. Okay, they're both steel, they both they work. Lovely. I would say for most people that I've encountered who have that kanila kind of issue. Yes. And you know, as a variable, those may be things to evaluate and say, I know it's not the darn insulin, I can give an injection with the same bottle of insulin and my blood sugar moves the way that it's supposed to, let's change the site. It's not necessarily the site, it could be the canula, we change the canula. magically, things look better, sometimes we even need to go down in the insulin needs because you're responding better. So

Scott Benner 43:32
I would have to say at this point that when you buy a pump, you're going to get instructions from the pump company about approved sites to use. Keep in mind that the pump company had to get the pump through the FDA process. And every site they wanted to test took more time. And that took away time from them getting it to market for you. So had they decide had they had the luxury of more time, they may have tested more sites and the FDA may have said hey, this data proves that you can use it here too. I'm now not saying anything else about that. Other than you should consider that. Correct. That's all.

Jennifer Smith, CDE 44:15
Yes. And even some of those approved FDA sites don't work for some people at all.

Scott Benner 44:21
Just because it doesn't make them good for you.

Jennifer Smith, CDE 44:23
Doesn't make them good for you. That's exactly right.

Scott Benner 44:26
not approved doesn't make them not good for you. All we always take into account the photograph on my blog that Chris Freeman, the Olympic skier allowed me to use of him wearing his pump on his pictorial. I believe the man has the same body fat makeup of this metal microphone that's in front of me. Yeah, I think

Jennifer Smith, CDE 44:48
many women use jet fighter as well, even though they don't technically have. They've got pectoral muscles. They're just hidden underneath a breath. I

Scott Benner 44:55
love when someone shares like a cleavage picture with their pump on them. My daughter and she's like, never, never. And I'm like, Okay, I'm just saying this lady says it works really great. I can't wait for me.

Jennifer Smith, CDE 45:06
Right, right. Again, all those variables to definitely consider.

Scott Benner 45:12
You know where else variability exists in the foods that people enjoy eating. Some of you, for instance, just rocking it eating as many carbs as you can jacking up that insulin going crazy, but some of you are like, Hey, you know, I would like to have a slightly lower carb option without sacrificing taste or choice. And luckily for you, this is an ad for real good foods and they have just that not only do they have it, but they're offering you 20% off with the offer code juice box. Let me tell you more. First thing you do is go to real good foods calm there's a link in your show notes. But if you type it in your browser, it's all the same. Then you go to their products. Chicken crust, pizza, cauliflower crust, pizza, breakfast sandwiches, both sausage and bacon, and geladas 3d different flavors. Italian entrees have been added. And of course the poppers that everyone loves. Those of you who are already enjoying real good foods, they have a VIP text club list for exclusive offers. All you have to do is text RGF 2474747 to be added. Are you kidding me? You love texting people? Wait RGF 474747 you can do that. But you got to go check them out. Their foods are low in carbs and high in proteins and delicious. It's amazing what they've done. They've taken you know, the treats that you love and made them fit into your low carb lifestyle to amazing without sacrificing taste and I don't honestly know how they do that. It's probably Voodoo. I'm not a very like food sciency kind of guy so I'm just gonna go with it's possible there wizards real good foods comm use the offer code juice box at checkout to save 20% on your entire order. And considering their free two day shipping. That's a great deal. What do you see how it shows up? Like they send you an igloo in the mail or something very cold, chilly. Ooh, where

Jennifer Smith, CDE 47:06
are we talking about location here, I clearly had location for a different reason being a variable, location, being like travel. Travel is a variable. If you notice, changes in your blood sugar. When you are flying or traveling long distance, we usually find that over two hours of sedentary travel will usually require more insulin because of the sedentary nature and the potential bit of stress that travel brings in.

Scott Benner 47:42
We on a three hour flight. We always have to Bolus our two hours into a three hour flight. I never thought of it before. But it's constantly that

Jennifer Smith, CDE 47:50
Yep, yep. So I personally have found that I use about a 20% bazel increase. When I fly I get to the airport I turn the Temp Basal on so that by the time we get on the plane, it's already like circulating at a higher level. I continuing until we get the notice of descent and then I cancel it. And that works really well. For me I do the same thing on long travel and when we lived in DC, and we would drive back to the Midwest to visit family. That's a long drive lots of sedentary sitting in a car, the stress of driving on the road and everything I would need a Temp Basal increase for that. So traveling it of itself can be a variable for those on tube pump. The variable could be the pressurization in flight. Many people find and there's actually some really good I guess, blogs on what people found with the tube pump in flight. So the recommendation now is to disconnect before ascent. Check the tubing Once you're at cruising altitude check if there are any bubbles, purge them out with a priming bolus and then reconnect. Same thing for descent disconnect once you land look at the tubing clear the bubbles if there are any. Some people have noticed that they get a bit of insulin bolus that won't show up in the pump because of pressurization of the pump and the reservoir and everything. Some people find that they've got this huge air bubble in their tubing. And so if they didn't look at it, they would get a huge missed amount of potential diesel or Bolus the next time their pump pumps out and that's something

Scott Benner 49:22
with the change of Evo elevation.

Jennifer Smith, CDE 49:26
Yeah, it has to do with the pressure pressurization within you know, the cabinet. Unfortunately, there's not a lot of In fact, there's nothing that I've seen in any of the tube pump companies that they talk about doing that, but it's something that we know is common

Scott Benner 49:43
to happen to

Jennifer Smith, CDE 49:45
an army pad obviously there is no tubing. I've had a random couple of people who've noticed that in flight they have these lows, having not bolused having not done anything different having sat at the airport for like an hour or two before their flight took off. Again, no boluses or anything, and they are low through the course of the flight. So I potentially I guess it could happen even without the tubing component there. I mean, the pod still have a reservoir. But I've really primarily heard it with tube pumps. I always wonder about

Scott Benner 50:18
you. Some people get like, like, we all most people have the same reaction, right? Nervous upset adrenaline, blood sugar goes up, but you do see sometimes, like people have the complete opposite reaction that you expect from them. And it's that's their norm, right? Or, like, here's one, how come when Arden has a head cold, it's like she doesn't have diabetes anymore. And other people say when I'm sick, my blood sugar goes through the roof. Arden gets sick, her blood sugar goes to 80 and sits there for days. It's far right. And it's just so the other variability that we haven't spoken about yet is you? Are you right? So your response? Yeah, your response to all of these things. So you know, the variables may treat you differently than other things.

Jennifer Smith, CDE 51:04
Similarly, I have my friend, who I have done races with in the past, not recently, but she actually has a considerable drop in her blood sugar once she gets to the race day.

Scott Benner 51:15
Okay, that's it. She doesn't have that adrenaline spike, she had the opposite. I mean, there's adrenaline there, but whatever reason it's causing her to drop. Yeah. And so for Jenny's friend, the the point here is, don't say, Well, I heard on a podcast that you know, when adrenaline hits your blood sugar goes up, and everybody online says it, but mine goes down. Don't don't bang your head against the wall. Just accept it. That's what happens to you and address it accordingly. Correct. There we go.

Jennifer Smith, CDE 51:40
Yeah, exactly. The other travel one was altitude. Many people don't consider altitude. And if you are someone who goes to Colorado skiing or somewhere fancy in Europe, and you go skiing, or whatever you do, you could notice that going to altitude, I noticed it when my husband and I took a trip to Peru, and we hiked the Inca Trail, which is we got to Cusco and we were like, Oh my god, can we just pleat the it like the altitude was like crazy, we felt like we had never exercised before. And my insulin needs go up about 30% for about 24 to 36 hours, once I get to altitude, and then they come back down. It's like my body just needs this like adjustment period. And then it kind of comes back, you know, to my normal. But that's a pretty common one to consider.

Scott Benner 52:32
And that is incredibly common. And even though it is incredibly common. There are three people that I know of right now listening to this that are thinking, I it's the complete opposite of what happens to them. I correspond with people who live in Colorado and are afraid they're going to die because their insulin just crushes them. They use the tiniest bit and if their blood sugar's falling constantly, they don't know why pumps injected doesn't matter. They just the elevation, that altitude just it wrecks them. So yeah, that's their that's their normal, you know,

Jennifer Smith, CDE 53:02
that's their normal. That's right, absolutely. So you know, all those, I guess, all those things to consider. You know, they're all there are lots and lots and lots of variables. What else is on my list? I have

Scott Benner 53:15
Jenny prepared for you people, I hope you appreciate that. I did.

Jennifer Smith, CDE 53:19
I did just because I was like, gosh, there's so many of them, I need to like make sure I get the primary ones that I talked to people about considering, you know, a variable I know we've talked about previously, when we're talking about like being bold with insulin is high blood sugar itself, like extreme high blood sugar can be a variable in how you expect your body to respond to insulin. Typically, when blood sugars are higher than about like that 250 Mark, which, huh? You know, they recommend testing ketones anytime you're higher than 252. Right. So along with that comes the consideration. You've got it all like squared away, you know, your bazel you know, your sensitivity to boluses to correct blood sugars, or carb ratio is all dialed in, and you feel like things are working and, wham, you're high now. And you take your correction and you're like, well, that looks like I've put water in my body. And it did literally nothing. It was sugar. So we've got this like, like this toxic state almost like they actually call it glucose toxicity that comes into play when you've got extreme high blood sugars, where you'll need more insulin than your sensitivity factor would normally cover. And

Scott Benner 54:37
that's what people commonly say, I'm insulin resistant when I'm high. That's the that's the common way that people talk about. So if you have that feeling in your head, this is what Jenny's talking about. Now, from my very non scientific perspective. I learned years ago and we've been talking about here forever, that bringing a high blood sugar down and coming in for that landing that you're hoping for And not a crash, right? it you have to In my opinion, it's a mix of Basal and Bolus. JACK, you don't just, if you're thinking, in my mind, if you're thinking it's two units to get this 300, back to 100. I like to find a good portion of that insulin from Basal. And I don't know why that makes more of a difference, but it certainly does. So

Jennifer Smith, CDE 55:24
it's also a, I call it a, let's say a safer way to also manage potentially, because if you've got a Temp Basal increase, going along with a part of a Bolus that you've used to address that higher blood sugar,

Scott Benner 55:40
the bazel can be canceled, right? You can always bail on Okay, once you see the

Jennifer Smith, CDE 55:44
movement that you want, you can bail on the Temp Basal, whereas if you've taken your rage bolusing you're like, it's telling me all you need two units, man, I'm gonna nail it, I'm going to get it down with like eight units and you like nail? Well, once it's there, you can't get rid of that eight units, it's, you know, whereas

Scott Benner 56:00
you just Pre-Bolus for your next meal, you better eat it at the right time.

Jennifer Smith, CDE 56:03
That's exactly right. So you know, if you do some of it as Bolus, like you said, and some of it is this Temp Basal insulin, you can cancel that town, you may need to cover a little bit, but at least you're gonna drift down better without a huge crash. And

Scott Benner 56:17
also, you can also cancel it and go back to it, which I found myself doing before, right? You're, you know, 300, it's now it's 280 is 250. And then you're like, Oh my gosh, it's two hours down, I'm shutting the bezel off, then all the sudden 220 levels out like, Oh, she left the bazelon. And you put it back on again. But at least you're in control of it to a degree, right. And you and you didn't just put in this giant like, you know, mallet full of insulin that you can't stop. It's hard to walk when you're done with it. Yeah, I want to say too, and this maybe doesn't fit here. But when you find yourself in those situations, I think it's incredibly valuable that when you cause that fall that that the sent in blood sugar, and you have to eat some food to stop. But at some point, I know everybody thinks of that as like some failure. But there's so much to learn from watching the food go in and watching how it affects your blood sugar on the CGM, that that that experience of stopping up drop like that will inform a lot of what you do in the future. Because just like you can see, oh, wow, I was 152 hours down. So I ate this. And I came in at at that knowledge. And I can't really explain to you how in the moment right now how in this example, but it will inform your understanding your greater understanding in a way that will help you in the future. It's absolutely very neat to see how the food affects the insulin.

Jennifer Smith, CDE 57:40
I see. So awesome. Yesterday, I talked to somebody who she worked very hard, you know, with strategy management, we knew something was kind of going on in the evening for her. So we said let's do like an evening bazel test, let's see what's happening truly behind dinner without the dinner, you know, being there. So she did this awesome bazel test, we saw the drift happened that we kind of assumed was from bazel. We, you know, could counter it, but she ended up having to treat the drift down and she didn't want to eat at 10 o'clock at night. So she just treated the low. She had three glucose tablets to treat it. And she thought, you know, all we're getting out of this is the bazel test. So we know where to change things. You know what? So we could actually get the evaluation of what the carb intake she did, how much of a rise did she get with it from it, because there was no other food, there was nothing I mean, the only other food she had in her system was from lunchtime at noon, at 10 o'clock at night, there is no impact of that whatsoever. She had no exercise, we treated the low it came up, we saw how much she can use, I pointed out she's like, wow, we got like more done than I thought we got done. She was so excited that she could actually see. And it was simple sugar, right. So she didn't treat with something that had the fat or the protein that would have later potential impact that you couldn't figure out. It was just glucose tablets.

Scott Benner 59:05
So there's so much to learn to learn if you just step back a little, and widen your vision. And and you know, and you have to get rid of that I failed or this is a mistake or a problem feeling. It's just data coming back like look at it and really accept what it is instead of being upset with yourself. Because you can't because I said it this you know, I say it a lot. But this weekend, I was really pointed with a pretty large group. I said, Every time something goes the way you don't want it to go. And you don't use that as a as a moment to collect the data and make decisions and, and and further your understanding. You wasted that moment. And you're going to have to have it again now because you didn't pay attention to what happened. It's just like, I mean, what's the saying right? Something about history doomed to repeat it right? I don't know the exact thing. Right? All of you who know it now are repeating it in your head in your car. But that's the idea. The idea is it's happening. Learn from it. Don't just read Your hands like I can't believe that happened. That sucks. I bet at this, you know, right. All that's true, but isn't going to help you the next time. So right, cool. Jenny Kiki, anything else? I mean,

Jennifer Smith, CDE 1:00:13
I yeah, I had two other one was something that I think is not addressed. Usually not addressed at all, unfortunately, health factors, I guess that we don't really want people you know doing really it's things like smoking. If you're a smoker, I'm sorry, but you know what smoking can have impact on on on blood sugar and some of the research that's out there that can actually show that smoking can have an impact by causing some insulin resistance, because cooking is it's suggesting inflammatory responses in the lungs,

Scott Benner 1:00:50
that make sense.

Jennifer Smith, CDE 1:00:50
So could have impact blood sugar wise, the other one would be drugs. Drugs can have impact potentially, on your diabetes management. You know, depending on the kind of drug that you're,

Scott Benner 1:01:03
you're telling me that if I'm sitting at home, really trying to figure out my insulin problems, and I'm not taking into account my heroin addiction, I make I'm leaving something out that's important to think about. Absolutely. Which which might be, which might be reasonable like that. I think that people compartmentalize their thoughts sometimes. And you really sometimes don't see where the impact is actually coming.

Jennifer Smith, CDE 1:01:25
Yeah. And as a variable, you may not be considering all of the things that you could be doing for your diabetes management. If you are utilizing a drug and it's, it's really your main like focus, right? Because diabetes isn't going to be a focus for you, then are you gonna say drinking next? Because I have one I

Scott Benner 1:01:40
wanted? Yeah, I'd say alcohol.

Jennifer Smith, CDE 1:01:43
Yep. Alcohol itself drinking, it's a big one that I discussed with, you know, my teens and my college. Because it comes into the picture it does. Learning how to do it safely, is an important thing, because the impact of the alcohol itself, you may have your fancy sugar, you know, juice sweetened beverage, the alcohol in it, however, is going to have impact later on your blood sugar. So what we find is that hours later, if you've had enough alcohol, it could cause a drop in your blood sugar.

Scott Benner 1:02:17
And and not for nothing. But when you're really loaded, you're probably not doing your diabetes, math as well as you probably could be wrong. Oh, is it fair to say maybe have a buddy with you explain to them why you don't just need a sober driver, you might need a sober bazel tester to watch these things just made me think of, because I just did an interview with somebody who's like clinically depressed and has type one. And to watch the cycle of how it hit this person over and over again, was just like, it's crushing, you know, to see, but for them to have to live with. So now I'm thinking, if I'm on a depression medication, is that affecting my blood sugar? Is it making my blood sugar higher? Giving me anxiety more that it's higher end, making me feel more anxious about you having to use extra insulin in what about just the, the, the physiological, and maybe you don't know, but experience of being depressed? Like does that have an impact on you?

Jennifer Smith, CDE 1:03:20
It's, well, depression as a stress, right? So it could be it could go various ways, if the depression isn't being managed with, you know, assistance, whether it's counseling, or use counseling, and medication or whatever it might be, you know, that in effect could be enough of a stress that it is bringing your blood sugar levels up. It depression can also mean that you're just, you're just not eating. So it could very well maybe bring insulin needs down because you're just literally not taking in anything through the course of the day. Now, some of the some of the medication, some of the oral medications will make you feel so much better, which is a purpose, right? That's the purpose. But some of them also increase appetite. If it increases appetite enough, and you're not cognizant that that's what's kind of happening and kind of rein that in, you could have weight gain that could impact your influence sensitivity.

Scott Benner 1:04:19
I'm gonna add a thought to this, because I had a conversation with somebody online, told me something I never considered. So this person was overweight. And eating was more than they wanted it to be. And so when they counted their carbs and went to give themselves insulin, they wouldn't give themselves all the insulin they needed, because it reminded them that they were eating more than they wanted to be eating. I know that's a real interest. You have to wrap your head around it for a second, but they were disappointed in themselves for eating that much. And one of the ways they pretended that it wasn't going on was to use an amount of insulin that a more normal meal would have been Yeah. So there's a lot of things I wrote, you know, as we started this conversation today, I wrote down life because the variable really is life. Right? Like, it's your living, and there are different things happening to you. And whether you're, you know, addicted to drugs, or you're depressed, or you just don't have your bazel, right, or, well, all the things that Jenny's brought up here today, really, it's just, it's, you're alive, and you have diabetes. And so they're going to be variable. So are there any more on your list? You're looking at the

Jennifer Smith, CDE 1:05:28
only other one was a

growth cycle?

Scott Benner 1:05:34
Oh, growth, are you?

Jennifer Smith, CDE 1:05:36
And I think, you know, I mean, that is a it's a broad topic. So I bring it out as a variable. It may need full nother discussion, potentially, but it is it's, and people ask, and I work with a lot of kids, lots of ages. I mean, a little younger than two is my youngest person. And kind of up until like, the 70s is my oldest and but the kids have these variables of growth that just drive parents crazy. Because become, you know, we've got things smoothed out and beautiful in the biggest things I tell people is the needs will change. We'll get them figured out. They'll probably look like they're going along pretty nice and that you know, little Johnny is gonna burn up, you know, a half an inch and so for the next couple of nights, they may get these like, like you said, aren't goes to bed and her blood sugar, kind of like drops off in a growth spurt. Many kids go to bed as soon as their head hits the pillow pillow and they're snoozing, man, it's like a rocket ship to the moon

Scott Benner 1:06:42
blast off blood sugar is the worst part about growth hormone and children is that it happens while you're trying to sleep. That really I have to give Arden her balls really quickly. This one's gonna be easy, though. Because Arden's doing the loop right now at carbs. taco. That's it. Time 10 minutes from now

at carbs taco time, change time to 10 minutes from now, that isn't gonna make sense to you guys yet, but it will one day when Jenny and I talked about that and and Katie de Simone comes back on and tells me all the things I did wrong while I was setting up my Ardennes loop. And how good and how I could have avoided them.

Jennifer Smith, CDE 1:07:35
Yes, I get it. That's great. Cuz that was like laying last little tidbit of variable, which is a total different discussion. I'm glad you're going to have it with Katie. But you should discuss with her the looping variable. Because these all have different if you are using a looping pump.

Scott Benner 1:07:55
Jenny, this is going to come out before I talk to Katie. And so I'll just tell you now and then you guys can all hear it. Now then hear me talk about later with Katie. Every every thought I had trying to set up the loop was wrong. Like like you don't mean Up, down left, right? Like everything. If you asked me, you know, yes, though, I'd say yes. And you'd like to know, you know, I send genic effects. I'm like, I'm seeing this, should I move this up? She go no down. I'm like, how do I get that wrong? It's just it's so so all of us. Right now everybody who's listening. If you're being bold, if you're following along with this podcast, obviously, it works fantastic. And there's no you don't need to change. But if you go to looping at any point in your life, or into a closed loop system, the variables, the settings that allow the loop to think are counter intuitive to what we're all doing. We're not looping, but I am putting myself through this so that I can explain it to you all better. Because if you guys want to move to a closed loop in this future, I think that's not a bad idea. And I want to make sure you understand how to transition from being bold with insulin to being I don't know, bold with a blue,

Jennifer Smith, CDE 1:09:08
or how to maybe let loose Be bold with itself.

Scott Benner 1:09:11
Yeah, yeah, there's a way but trust me, I still only understand that about 65%. But by the time I'm done talking to Katie, and by the way, now that Jenny has been kind enough to say that she's going to continue coming on like this. I don't think we'll be putting them out like three at a time, but maybe once a month, or as often as Jenny can do it. And trust me, we're going to get about that as well. So thank you so much for doing this.

Jennifer Smith, CDE 1:09:33
Thank you.

Scott Benner 1:09:36
Wherever you are right now, I imagine you applauding for Jenny just a slow, deliberate and lovely clapping. That's how I feel every time she's on. Hey, how about that great news. Jenny is going to keep coming back on the show. The diabetes pro tip series is going to go on into the future non stop pro tips. Just for you guys for listening to the Juicebox Podcast. Don't forget to check out Jenny at Intuit. To diabetes.com there's a link to her email right in the show notes. Don't forget dexcom.com forward slash juicebox get started with the G six today, dancing the number for diabetes.com. And of course using the offer code juice box at real good foods calm. I love getting all of your ratings and reviews on iTunes. Thank you very much every time someone leaves a great iTunes review for the Juicebox Podcast. I don't know if you know this or not. An angel is completely unaffected, but I am incredibly happy

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