#295 Defining Diabetes: Insulin Resistance/Overbolus
Scott Benner
Defining Diabetes: Insulin Resistance/Overbolus
Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
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Jenny Smith is back today Jenny and I are going to define insulin resistance. And it's not exactly the way you think of it, which is why we're bothering to take the time to talk about it. We're not just like, whoo, pick something everybody knows. You think you know about insulin resistance Jenny gonna shine a bright light, a bright light on what it means. While you're listening to Jenni spin her genius. Try not to forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And that you should always consult a physician before making any changes to your health care plan. or becoming bold with insulin. I could say that my sleep by the way. All right, I'm not gonna make you a bag. We're gonna get right to Jenny. Don't forget, by the way, if you want to hire Jenny, she works for integrated diabetes, you go to integrated diabetes.com to find out about Jenny. Jenny is not a sponsor. Jenny is my person. So I don't get anything out of it if you go except good feelings. So you can go through my link if you want. If it makes it easier for you. You just type right into the browser don't matter. Here we go. Here we go. There we go. Here we go.
I would like to define insulin resistance
Jennifer Smith, CDE 3:59
and insulin resistance. That's a good one a very good one. And I'll tell you why.
Scott Benner 4:03
Why does this one come up on my list? It's because again, I think it's the same thing as brittle in a different in a different avenue, the same idea? Maybe not always. But I think I think there's insulin resistance and there's reasons for it. But first, can we define it?
Jennifer Smith, CDE 4:21
Sure. I mean, insulin resistance is essentially the body's pushback, a simple, I guess, simple definition, the body's pushed back in appropriately using insulin, right? It's just not it appears that insulin is just not working the way that it's supposed to people with insulin resistance and that which is a technically a hallmark of type two diabetes is insulin resistance because in the early phases of type two development, there's actually a huge output of the pancreas producing more insulin like loads of insulin to actually overcome the higher blood sugar levels, but their body's cells are not responding to the insulin, the right way to the body just keeps pumping out more and more and more insulin and offense. Eventually, with type two, the pancreas gets pooped out. I mean, those cells are like God, we just we can't put out like more and more and more, we're doing enough and it's just not working. It's a bit different in type one diabetes. I mean, there are, there are some hallmark, like diagnostic reasons for true insulin resistance in type one. One of them is weight management, the the heavier that you are above, your body's like, target healthy weight, the more resistant you're going to be to using insulin, the insulin is just not going to work as well in the body. Another one specific to women is something called pcls, polycystic ovarian syndrome, and that, that actually causes a whole like series of metabolic changes, one of which, however, is insulin resistance. A woman with pcls will usually need a lot more insulin to manage. And it's based on a hormonal component to the ovarian syndrome that's kind of going on.
Unknown Speaker 6:20
So
Jennifer Smith, CDE 6:23
in general, though, insulin resistance with Type One Diabetes, if you are, you know, your healthy weight, active and whatnot, everybody's insulin needs are very different. So when we talk about insulin resistance, I think a lot of people might look at a friend of theirs, who's the same height, weight, you know, doing the same kinds of things. And you're like, Well, why am I using double the amount of insulin is dumb? What's the deal, I must be insulin resistant. That's not the case at all. I mean, I've got a friend who's actually, she's tiny. She's had diabetes several years longer than me. And I've had 31 years, and she actually uses more insulin than I use. She's only five feet tall, and she probably weighs 10 or 15 pounds less than I weigh. And, but she us and she's very active. Um, she's actually roller derby. She's done a couple of like, full distance Ironman, you know, events. And so, in that, I think sometimes there's a lot of confusion, confusion around how much insulin Should I personally be using? It's different for everybody. Gotcha.
Scott Benner 7:31
Okay. So I brought it up. Because engineer, can we slide your phone slightly away from the microphone, I think, yeah, absolutely. I think I brought it up. Because I know it's a real thing. And I wanted you to explain what it really was. But I also know that people default to saying it too frequently, when I don't think that that's what's going on. Right. So a great example would be if you're dehydrated, and you know, you're using insulin, and it's not giving you the you know, the response that you expect. And then you hear people say, Oh, I was, I was really insulin resistant today, but you weren't really insulin resistant. Today, you were really dehydrated today. And so and it because and the reason I bring it up is because I think the idea of insulin resistance allows people to think this is something beyond my control. So I'll just accept it. That's what that's why I brought it up. Because that worries me for people when that happens, right? Great example, is I've been helping this really wonderful family recently with a 16 year old boy who's, you know, an athlete plays ice hockey. And yesterday, the kid went to an ice hockey game and got to play the game, like right around like 95 the whole time, you know, didn't cross out crash low afterwards or anything like that. And I realized that prior to that, they were doing the like, will get his blood sugar higher thing. And you know, and he didn't feel well, he feels so much better now. And all this stuff is great. And it's really cool. But they were living in a false narrative before, right? Like, this is what's happening to me. And so I have to accept it, or I have to do this thing that I don't want to do, because this is what's happening. And and I don't think people should. I don't, I don't want to say I don't think it makes me sad. Honestly, when that's happening, you don't mean like, I don't like the idea of someone running around going, Oh, my blood sugar was 250. Today, I was just insulin resistant, when there could have been a real reason for it. So try to just keep in your head. The difference between what Jenny just explained with insulin resistance really is like for instance, a pregnant person could use a significant amount of insulin right then then they would even have five seconds before they're pregnant. We're in their first trimester versus their third trimester, like all these different ideas, but that's not that's so that's that. Okay, so I just please
Jennifer Smith, CDE 9:53
and I think a good thing to kind of put in there with that is that there may be times when Insulin resistance is a piece of what is happening, like you just brought up pregnancy, right? There is a piece of points in pregnancy where Yes, insulin resistance comes into the picture. But why is it there? It's not that you're going to be insulin resistant for the next 90 years after the child is born. It's the fact that there's a hormone piece in the picture that's causing you to actually you need more insulin, you just need the hormones are causing that issue. So it's not like a type two, where the cellular level of response to insulin is actually a piece of
Scott Benner 10:34
your so is it fair for me to say that, like I bring up on the show your body is for whatever reason, telling you, I have more of an insulin need in this moment. And you need, you just need to meet it. So if you are insulin resistant in that moment, there is enough insulin to use to overcome that blood sugar, right? It just it gets to a scary point for most people. And they're like I can't, the numbers get wrong, the numbers get wrong in their head. Like, I'm usually my base is usually a unit an hour. And I've never bolus more than four units for food. So they just won't go bigger than that guy. And people who and people who haven't gotten their bazel right and done all the things we talked about in the podcast probably shouldn't start crazy bolusing like that, because they are going to have a heart problem. But but the breath but the reason I bring up the boy with the hockey is because he can stay stable while skating and playing hockey now because his bazel insulins, right? Because he's bolusing on time with his meals because he doesn't have any unbalanced active insulin in his system that just pops up at weird times. And doesn't have a fight with food anymore. So it just kicks his ass instead. Like, right, correct. Okay. All right. Thank you. This is my my, my defining diabetes list is about like, all the sad things I hear people say. Can unit
Jennifer Smith, CDE 11:52
No, let's clear that up. No, that's not right. Let's make sure you understand that better. Yeah, I
Scott Benner 11:57
just I look and I think oh, it's sad that that's what, what what is thought? Right.
Listen, I'll give you a quick story, right? And then I'll ask you to define overbought listening. I made a diabetes podcast, the very, very beginning of 2007. And because of Excuse me, I made a diabetes blog in the very beginning of 2007. And because of the nature of the internet at that point, I didn't really know the other diabetes box. Like there was a little while where I thought to myself, Hmm, I am doing something so cool that no one else is doing Why did no one else think of doing this? I am a genius. I felt like the Magellan of like diabetes blogs. Right? I was just looking around. I'm like, why couldn't know how Scott's idea is so much stronger than everybody. Then I realized there were a couple other diabetes bots. Right. And there had been a number of them proceeded mine. I had no idea about them when I started mine.
Jennifer Smith, CDE 13:14
But I had, I think, I think Carrie sparlings was one of them. I think she started in 2005 or 2006.
Scott Benner 13:20
Definitely, definitely carry Scott Johnson probably.
Jennifer Smith, CDE 13:24
Yeah, maybe diabetes. Yeah,
Scott Benner 13:26
maybe George Simmons to like, if I'm thinking correctly, there were a handful of them. I was in the beginning. I just wasn't the beginning. But I had, I had this feeling that I was right. And similarly, I do this thing where I avoid other diabetes information. I know that sounds weird. Maybe when I say to people, but I don't listen to other people's podcasts. I don't read other people's blogs. I don't want to be impacted by other people. Because I want to come to these ideas on my own. Because when I come here, well, not only that, I can explain it if I know how I got to it. Right? When somebody just tells me set this there, that doesn't help
Jennifer Smith, CDE 14:03
me. It's like reading a definition out of a dictionary.
Scott Benner 14:07
Yeah. And then it doesn't help me to help somebody else. So I come up with this idea that we talked about in the podcast here, my house in my own head. What if I can't Pre-Bolus one day, how do I handle that? And then I came up with that kind of math that you've heard me talk about in other episodes, where I'm like, Oh, Bolus for the carbs. And then I'm gonna imagine the spike in Bolus for the spike. And then I'm gonna imagine the correction I'm gonna I'm gonna put it all in right now. And maybe I can get all this insolence so far ahead of that, that like a time travel movie, none of those things will ever happen because I killed the thing before it was supposed to happen, right? Mm hmm. Literally how I thought of it. And I started speaking about it and I called it over bolusing because I'm over bolusing. You can see how thoughtful so
Jennifer Smith, CDE 14:54
pretty fancy term there over bola. Thank you.
Scott Benner 14:57
And so our insulin board Over bolusing stop the arrows I am talking to myself like I'm for. And so. But anyway, it works. And then I was like, Ah, here I am again invent and stuff. And then one day you said to me, oh yeah, Gary calls that this and I was like, Wait, what? Yeah, but that completely makes sense that somebody else would have had the thought to. So what I call over bolusing is exactly what I just explained. It's the concept of getting in more insulin than you need for the current situation with the understanding that this current situation is going to get worse soon. And so you get ahead of the problem. But correct, but Gary calls it Super Bowl is saying, right?
Jennifer Smith, CDE 15:45
Actually, it's john Walsh, john. And we use that we use the term Gary uses the term too, but it originally came from my understanding came from john Walsh, who wrote pumping and pumping insulin. Okay, which from what I understand from people is a really great book. It doesn't it doesn't tell jokes resource. You don't get to hear Jenny while you're reading it. So Well, I mean, how?
Scott Benner 16:07
But but so
Jennifer Smith, CDE 16:08
it's, it's written in layman's terms. It's a good. I mean, it's not like a bedtime story or anything. But I like it from the standpoint of, you know, one of those books where you can go to a chapter that's like, how do I manage around exercise? Or how do I figure out bazel? Or how do I deal with these spikes post meal and over Bolus, right? Or Tino people? I think like you people think about, should I just take more insulin? I know that yesterday when I ate my cereal for breakfast. This is what happened? Well, what if I just took more insulin right now? Yeah, that's the same concept. It's, it's over bolusing, it's super bowl of thing, it's whatever you want to name it, it's just you head off the spike by just dosing more earlier,
Scott Benner 16:51
okay. And so to really to break it down, and we've done this and other episodes, but I want it to be here as well say that you've counted your carbs perfectly, but you have not Pre-Bolus. So you know, you're going to get a spike. And you decided that the meal is three, you know, three units, but the spike is going to happen because you didn't Pre-Bolus. And in your history, you found that that spike is going to go up to 225. Before it kind of before plateaus and levels off. And you know that it's going to take a unit to correct that to 25 back to 90. So then you put in 40 units instead of three, because you weren't able to pre Boss, I will I will absolutely tell you that. And I've said this one other time on the podcast. We don't Pre-Bolus as much as we used to, because I know how to overhaul us, right and it and I don't not do it. I always Pre-Bolus whenever I can. But when I can't, I guess I should have said I don't panic the way I used to write I just take care of it right then in there. Mm hmm. And, you know, that's a that's a definitely a another thing that you have to try over time, and there's going to be you know, there's gonna be
Jennifer Smith, CDE 17:59
some experimentation
Scott Benner 18:01
definitely gonna be experimentation for you to fail.
Jennifer Smith, CDE 18:03
And you know, you figure it out, you're super, you're like, I call it secret sauce to over bolusing. Right? You figured it out and you make it work. And, you know, I would say probably 98% of the time, you probably nail it because you've figured it out. And in terms of like, you know that that one unit you said before for the 225 blood sugar? Well, I know it's going to get here, you know, it's going to take a unit to correct and bring me down in a mathematical way, just for like definition of how could you figure that out, you can actually sort of back use your correction factor. You can say, you know, if I know that I'm going to start with a blood sugar of 100. I'm going to go all the way up to 225. And one unit brings me down 100 points, your correction factor is one to 100. Okay, one unit should drop you 100 you can say okay, 225, one unit will bring me down to 125. It's pretty close to 100. So let's just give a whole extra unit to the front of this food bolus, the pump suggested or I calculated three units for the food, I'm going to add on a unit without the time to Pre-Bolus or maybe it's just a really carby meal like cereal tends to be and so you head it off with that extra but that's a little bit of the math if you want a little bit more way to figure it out ahead of time. And then you know as we talked before, john Walsh's method with super bolus is really just to take, he does it by taking the bazel behind the meal. And he tacks that on to whatever the food beast Bolus is up front. So if you're, you know, if your Basal is running at one unit an hour behind the meal for two hours, that's two extra units of insulin. You take that two units, you pop it on to the Bolus up front, take it all at one time. And his recommendation is to then take the bazel down to zero. So your front loading with the insulin but you're also knocking off the back end effect so you end up not going low. Now again, there's some experimentation to that as well. Well, there's I've got some teens and young adults and even some kids who are taking the bazel down to zero, it doesn't work, they end up the Super Bowl is works, it prevents them from getting like that big spike, but they end up then staying too high later or going up again later because the bazel has been taken back to nothing. They still need it. So they need some of it. I've got a college student I work with and she does a 50% bezel reduction with a super Bolus. Okay, so there's some experimentation just like you found with your over Bolus.
Scott Benner 20:32
But yes, that's a good one. Listen, I made that word up in my house and I didn't know anything else existed. So in my mind, I'm again Magellan.
Jennifer Smith, CDE 20:40
You are you're over Bolus word you are. Yes.
Scott Benner 20:42
And if john Walsh had a podcast, he could tell us about his Super Bowls, but he doesn't. That's it all right now.
For all the people who don't actually get my sarcasm, I feel bad for how angry they must be at me while I'm talking. Like that guy. Every episode of the podcast and with Jenny giggling Thank you so much, Jenny Smith, for coming on the show today and sharing your wisdom with everybody. Don't forget to check Jenny at integrated diabetes.com link in the show notes at Juicebox podcast.com. And of course, our new sponsor the Contour Next One, you want to do yourself a favor, you want to do something, it's not going to cost you a lot of money but is going to add a ton of confidence and good feelings to you. To your life to your feels inside. Take away the stress and the anger. Take away everything. The worries go away. I'm feeling mountain away. Right? You never thought of it before. But a really solid, super easy to use small, like you know, completing your pocket putting the bag No problem, but it's still substantial in your hand. Right feels well made. You can hold on to it. You know, I mean, it doesn't feel delicate, like oh, I'm gonna lose it or it's gonna break. It's good. It's solid. It's not big, but it feels good in your hand. I like it. I'm just telling you right now. I don't want to do dirty the other meters that aren't used over the time but I'm thinking there's been a couple and ain't one of them been half couldn't hold a candle to the Contour Next One my friend understand Contour Next one.com such a simple thing. You've been walking around with his old dirty nasty meter that you don't trust for EVs. Why are you doing that? So simple to get yourself going with the right one? That easy? Right? Tell your doctor next time in the office. Yo, yo, how come? I want to get the Contour Next One meter. Make it happen. write the script script out. Or like I said, Contour Next One comm check that out to all kinds of ways to upgrade your diabetes. I'm all sorts of jacked up right now. Do you want to know why? You probably don't care. I gotta fly tomorrow. Oh, I hate flying. I'm trying to keep my energy up. I can't wait to get to the jdrf type one nation event in Oklahoma on Saturday, and go in there and do what I think is gonna be the magic. I am gonna really whip it out. I think I've given like four talks in the day. It's gonna be wonderful. I'm super excited about that. Here's the part. I'm not excited about driving to the airport early in the morning tomorrow. Oh, not good. getting on a plane with sick people. You know, they're sick. Right? And I'm not a germaphobe but it's January is cold out. You know, people like wipe their hands on their nose. Touch a part of the plane, and I'm gonna touch a part of the plane. Next thing you know, I'm not gonna feel good. I don't like that. Then I gotta fly somewhere. Now, I don't mind flying. But I hate layovers. And apparently, there is no way to get from where I am to Oklahoma without laying it over. So I'm gonna fly North tech go, like sad. I don't really know where Oklahoma is. But I'm like Southwest. I think I'm probably going right. Oklahoma, Oklahoma, where the wind? Yeah, it's probably like Southwest. I have to fly north to go Southwest. I don't want to do that makes me upset just thinking about so instead of being upset, I'm keeping up my good energy today. being excited, have a little bit of fun, trying to keep my focus off of it. I'm going to do my best to put up a couple pictures on the social medias while I'm there. So you if you're following me on Instagram or Facebook, that's where I would do that. What else? Yo Are you in the private Facebook group for bum in the bowl with its own Facebook page and there's like a private group of people talking about management stuff and other good things. Lots of good peeps in there. Go check it out if you want. Gotta be something on someone to tell you. has to be
I'm speechless. What is this gonna happen again? All right, I'm gonna go pack and get to Oklahoma. I hope I see you there. Or at one of my many events coming up, check them out. Go to Juicebox podcast.com scroll to the bottom, click on You'll see where I'm going to be in 2020 got a lot going on. Think I just added the Phoenix area in May. It's not locked down yet but have a good feeling about it. Um I might be having a good time recording. I don't want to stop but I have nothing left to say you're probably pissed now. I'm gonna let you go. Goodbye.
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About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
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