#470 Diabetes Pro Tip: Weight Loss

Understanding how insulin works is the first step

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 friends and welcome to Episode 470 of the Juicebox Podcast. Today, we're adding to the diabetes pro tip series with an episode that has been asked for by listeners forever. And for that reason in many others, I'm very excited to give it to you today.

The diabetes pro tip series from the Juicebox Podcast began almost two years ago now, when I decided to take the tools that were being spoken about in the podcast, and condense each one into its own episode. That was my original thought anyway, the pro tip series has become so popular that it's just you know, it's like watching a baby grow up and you just kind of go like oh my God, look what they're doing it. It's become more than I expected, and it continues to grow. And today is another another link in that chain, diabetes protip weight loss with Type One Diabetes. Please remember why you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. In just a second, I'm going to tell you a little bit about Jenny, a little bit about the sponsors and where you can find those other diabetes pro tip episodes. Then we're gonna jump right in

this episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump, and you may be eligible for a free 30 day trial of the Omni pod dash right now. And you can find out if that so at Omni pod.com Ford slash juice box Get started today with the Dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box. And if you're looking for those diabetes pro tip episodes, you'd like to start from the beginning, they started Episode 210 with an episode called diabetes pro tip newly diagnosed or starting over, he does a series it's made to be listened to in order. And it's of course available to you as a subscriber to the podcast. All you have to do is go back in that podcast player to Episode 210. And there it is. If you're having trouble finding the other episodes, you can look at Juicebox Podcast comm there's a tab at the top that says diabetes pro tip. If you don't want to go to all that trouble, go to diabetes pro tip.com, where you will find the pro tip episodes and the defining diabetes episodes, which I also am very fond of. In just a moment, Jenny and I are going to get started. But first I want you to know that Jenny Smith has been living with Type One Diabetes since she was a child. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitors. Jenny happens to be the bomb diggity. I love her. And in a couple of weeks, her 33rd diversity is coming up. So if you're in the private Facebook group for the podcast, please take a minute to go to the thread celebrating Jenny and leave her a little message. And I'll be passing those messages on to her on her diversity. Last thing I want to thank the listeners who sent in questions for this episode specifically, we get them about two thirds of the way into the episode. But first, Jenny and I are going to talk about ways to lose weight when you have type one diabetes. Every time I think there's nothing more to do for the protests, then somebody asks something and I think No, no, that that would work there too.

Jennifer Smith, CDE 4:01
Is the variables in life that I think will always bring in something to discuss in terms of what it could be in, in diabetes? Like management? Yeah,

Scott Benner 4:13
no, I'm really happy. I'm really happy to hear from people because I think that others perspectives can make me go Oh, yeah, wow. Just because that hasn't happened here. Doesn't mean that's not happening somewhere. And then if it gives you no good focus for what to do. So this is it. We're gonna talk about trying to lose weight, you have type one.

Jennifer Smith, CDE 4:32
As I mentioned, I think I texted back to you. I was like, this is a big topic. It's not just like five minutes of just go out and start running. I mean, it's it's kind of like a rabbit hole, honestly. I mean, there are many different like, little avenues to kind of talk about and you had a lot of really good questions that came in, or like comments about Gosh, I don't understand this or why isn't this quite right or whatever. So

Scott Benner 5:00
Yes, we actually knew three topics. So I'm gonna have very little to say here probably. And I apologize for that. I guess this is the time, the time we pretend like I just came on your zoom. And I'm like, hey, how do I help? And then you just talk. But what what's the I mean, where do you think we should start? Because to me, I think we should start at the idea that people correlate taking insulin with gaining weight. And then they don't think about calories and get that right. Go. Hi, Jenny. Oh,

Unknown Speaker 5:34
you help me please? Yes, well, maybe.

Jennifer Smith, CDE 5:39
I know, it's a good place to start in terms of like, one thing that everybody with diabetes specifically thinks about is that it's insulin. And I think a good place to even go with Why does that start is because it's often something that a practitioner will tell people, you know, using insulin, you may be likely to gain weight. I think that was one of one or a couple of like, the comments that came back about this topic, were specific to you know why I've been told that I'm going to gain weight or why, you know, why is this going to happen? or Why did I lose weight, and now I'm gaining all of this weight back like after diagnosis, right. So insulin itself, whether your body makes it or you take it with an injection or with a pump, it's a storage hormone, that's its job, it's supposed to move a certain quantity of carbs, sugar really out of your bloodstream and into places to either be used or stored, right. So in terms of management, insulin can make you gain weight. In terms of like initial diagnosis, a lot of people with type one specific have lost weight. Prior to diagnosis, maybe it was very rapid. Or maybe it was like a lingering loss that people were like, well, I could just keep eating the whole cake. And Gosh, I don't gain any weight, and I'm actually losing weight. And then they're like, wait, this is wrong, this is bad, that shouldn't be happening. So they go to the doctor, right, they get a diagnosis of diabetes, they've lost weight. And in terms of that loss, it's often relative, it's usually a relative to the fact that their blood sugars have been so high, that their body isn't storing those calories, right. So you're essentially paying them out, thus, decay, and all of those things that can come about, you know, around diagnosis time, but because you're losing all those calories, and your body's not packing them in, once you have back the piece of the puzzle that was supposed to help you use that food that you were taking in, your body's gonna start storing it.

Scott Benner 7:43
And so and so. And that is the one confusion you see from newly diagnosed people, like I don't understand, I lost all this weight, and they don't understand the function of it. So explaining the function of it, I think is great. I think boiling it down into one simple idea is that you were dying. And yeah, and your body is using itself up and not storing at the same time trying to stay alive. And then all of a sudden, everything's all right. Now, the more weight at Listen, if I'm if I'm talking about a school, here, you're stopped me. But if you've lost a lot of weight, before you get to this skinny, emaciated, those are my ribs, you probably had weight to lose to begin with, right? Because it was there to lose,

Jennifer Smith, CDE 8:22
likely and especially more as the adults who are diagnosed Yes. If you had weight to lose for whatever reason, you may have just thought, like I said, Oh, good, I'm actually able to take weight off. Now. I don't know why I'm still doing the same three mile walk every day. And now it seems to be working better. Great. But yeah, once you get to that, like, I shouldn't be able to see my lower ribs or Gosh, my face looks really sunken in when I look at old pictures. That's not what you want.

Scott Benner 8:52
And I think that, again, I this probably sounds I don't want it to sound like distasteful, but if you had weight to lose, you were probably it's likely that you were taking in calories that helps you stay at that weight. Meaning that when you start taking the insulin back in, there are calories there to be packed away to facilitate the weight gain again,

Jennifer Smith, CDE 9:14
and that's in any case, whether you could have lost weight, you know, and successfully hopefully helpful, you know, left it off. But the goal was starting insulin is in general to maintain a healthy weight then right to get Yes, you will come back from the weight loss, but you should also with the proper insulin dosing, you should be able to get back to a stable healthy weight. You know, if you lost 40 pounds when you were diagnosed and Hey 20 of that you could have definitely lost and the other 20 you really didn't need to great, we should gain back maybe 15 to 20 pounds and then we don't need the other

Scott Benner 9:56
what is the functionality of the proper insulin dosing It makes you gain too much or not enough

Jennifer Smith, CDE 10:03
in terms of insulin dosing, that's correct. The amount of food you put in to work with it, of course, is a piece of the puzzle there. But if your insulin is being balanced along with your use of the energy that it's working with, then you should be able to gain energy back to your body that gets stored, that keeps you at a healthy weight, and you shouldn't then continue to gain if the dosing is correct. And it's so it kind of goes back to, on a baseline initially, make sure your insulin doses are right for you. And a lot of people wonder, you know, they, I just leave it to my doctor. Yeah, it tells me how much more or less to take.

Scott Benner 10:43
And does that mean that if you're not using enough insulin that your blood sugars are left higher, so you're still having some of the action that you noticed before you were diagnosed? Right? Yes, you're a little You're too high, and your body's not storing the, the calories correctly, the glucose collect correctly, and so you're not gaining as much weight. So you could have unhealthy blood sugars, but feel like your weights good. And then you kind of come to that point, you're like, Oh, I'm good. And that really is the beginning idea of diabetes aimia to write, manipulating the insulin to keep your weight down, okay, so that's going the other way, if you're too low all the time, you'd have trouble putting on weight.

Jennifer Smith, CDE 11:26
If you're too low all the time. One, you've that's actually kind of an, it's an opposite of what you would think really, if you're low all the time. And that's a big reason, then when we start working with somebody, we analyze insulin to begin with, and the first thing we look for, even if there are highs, high highs, we first look for lows, because if weight management is another piece that they're really concerned about, then all of those lows that you're treating, you are feeding insulin, and you're feeding insulin, which ends up packing away the excess that you're taking in, and you maintain a weight that you don't want, or you keep gaining weight that you don't want.

Scott Benner 12:11
So this, this puts you in the position of having to look at carbohydrates as medicine, and being scared because you're low taking away more than you need. And then suddenly, you're back back up again. And maybe you've got enough insulin in there to handle the carbs for your blood sugar. But you've taken in way more calories than your breakfast once got it.

Jennifer Smith, CDE 12:31
Yeah. Yep. So that's, that's that insulin is, it's kind of the key place to start really. And you know, then a lot of people ask, Well, how much insulin? Should I really be on? How does this enough for me? Is that enough? For me? I know, we just talked about that kind of in depth in another episode, but really, you know, figuring out about how much insulin you need based on a wheat to begin with. That's kind of a starting place that you could go to, how much total daily insulin Are you using right now? What's your like current body weight, etc? Should you be using this much insulin? is it taking this much more insulin to counter things? Or are you using like a heck of a lot more like let's call it Bolus insulin, right? But you see that your Bolus insulin is for a lot of corrections. And when you're looking at your data, you can see that the corrections are following lows. There again, more insulin than you really need. And thus your body is going to pack away by allowing the insulin to use up the food.

Scott Benner 13:38
It's funny because I wasn't 100% sure what you were gonna say today. And yet I feel like we're into this situation, again, where the podcast should maybe be three minutes long. And it should say limit your variability use the right amount of insulin. And it kind of addresses so many things. I know this isn't weight loss specific. But let me just ask you one question. How many people you know what percentage of people do you think just a guess, are are getting to reasonable outcomes by mistake. Like their bolusing too much, but they're eating on time and their basil is too low and it works out or their basil is too high and they eat before they get low. And they don't have to Bolus too much in it like how many people are getting there the wrong way, but it seems like it's working and then have underlying issues that they don't recognize. Like I

Jennifer Smith, CDE 14:35
wouldn't say it's I wouldn't say it's anywhere near a majority of people. Honestly, I'd say it's a small percentage of people who have figured out insulin needs. Even though the dosing strategy that they're using might be wrong, like you said, maybe there's way too little basil, but they're offsetting it with boluses and maybe the little amount of basil they're using is right for their overnights and that's why it looks stable or, you know, Vice So whatever. But I don't think that's the majority of people, I think the majority of people who are having issues with blood sugar fluctuations that they don't want, and also likely are having some issues with weight management of some type. It's, it's a start of let's look at what the initial factor could be insulin. And then you move on further. And you know, lifestyle is a big part of it, obviously. So then we look at things like calorie intake. And I think some of the some of the questions that came in were kind of, you know, around that, well, you know, I've run a calorie deficit, and I've like, run myself ragged, going to the gym, or, you know, exercising 90 hours a week. And it's still not working. But I, you know, and then, you know, there's the fasting component, and all of these things that people try to put into the picture. But from the standpoint of calorie, your calorie needs should meet your baseline kind of need, in general. And then if you were working out on top of that, or you know, a training athlete or whatnot, then calorie needs go up. But at a minimum, there is kind of a minimum, on average, that needs to be there. It's about 1000 calories a day, give or take person to person. But when you start dipping below that oftentimes what ends up happening is your body conserves. Because you're not meeting a need. And then you wonder, Well, I'm at a deficit, why am I not losing? Because

Scott Benner 16:38
your mind thinks you're lost on a desert island, and it doesn't, it's trying to hold on to everything you put inside? Exactly. I had that problem where I've, by eating more food, I've lost weight and eating less. It didn't, it didn't impact me as a fact. In fact, it sort of made me go the wrong way. So okay, so if someone asks you, is it not as simple as Hey, I need to lose weight? Can you tell me where to start? Is it really person to person? Like, because what do you have to do first, like, think about if you were listening to this right now? And you could be any of the varied people who are listening? like where do people start?

Jennifer Smith, CDE 17:17
I would definitely say with Well, first might even be an analysis of Where are you? And where do you want to be? Or where have you been weight wise, right? What's your goal to get to? And how much more Are you above that, then you want to be and also in that timeframe, it goes back to insulin analysis. If you've gained weight, as many people have in this past year, if you have gained weight, but your insulin doses haven't really shifted, there in lies a piece of the puzzle to write usually, for about a 10% change to your baseline like Wait, you're probably going to expect a need to change your your basil and your Bolus ratio is by about 10% as well, to be more aggressive and to take, you know, take into consideration that gain now when people are looking for loss. They're like, Yeah, but I don't want to use more insulin, because that's not going to work

Scott Benner 18:20
anything. Insulin, put the weight on them. Correct. Okay, gotcha.

Jennifer Smith, CDE 18:25
But really, they need to first manage their blood sugars. And then they can start working on whittling away or wiggling back and some of that comes into, okay, let's look at the lifestyle things. Let's look at are you exercising? Are you active enough? Does your calorie intake meet what your actual need is? You know, where can we whittle away some things so that weight comes down and along with it, then as you do lose? The same thing happens with insulin, your insulin doses should be adjusted back based on loss.

Scott Benner 18:59
You're making me think so strongly about when somebody comes to me and says, Hey, I just got diabetes, and I play a sport or my kid, you know, is on the team and we're so worried about this and I very badly don't want to give them a band aid answer about how to get through the sport I want to tell them let's take the time now and get your insulin right so that during the activity there really isn't any issue and it's hard for people to believe that once they've seen it once they see cause and effect once they say I ran around and my blood sugar went down. They imagine that is going to happen no matter what all the time. And I Ardennes. I'm sure you're the same way. But Arden's insulin so well balanced at this point, like activity doesn't make her lower or higher. Really, it's not it doesn't really change too much.

Jennifer Smith, CDE 19:46
Yeah, it depends. I think that brings in, you know, the consistency of exercise or activity, right. The more attune your body is, let's say you go out for an hour every single single day to get some form of real exercise right Your body gets used to that. So initially, you might see that your insulin needs drop off within the hours of the active time, right, and maybe even stretching several hours later, depending on what you did. But over time, that impact is lessened, you will usually need to be less aggressive with insulin adjustment, or maybe not at all. I mean, I can typically take my kids to the park and not really worried too much about that, unless I know I'm really going to run around crazy with them, and I likely have insulin on board. Right. So then something needs to be you know, offset. But, um, so yeah, I mean, once you get to the point of like, lifestyle adjustments, and a base insulin that's working, your fluxes in insulin dose, then will be minimized. I think, oh, sorry, go ahead, we'll

Scott Benner 20:52
see I think people need to be certain to that, once they start exercising their body is going to use the insulin better. The answer then is not to feed the low, it's to adjust the insulin, you know, maybe the first time you have to feed it, but then you have to learn from there and make an adjustment so that you're not constantly battling yourself because that is what happens, right? They exercise they get low, they eat it out, though it out. It overpowers what they meant to accomplish, okay,

Jennifer Smith, CDE 21:18
and then they and then you end up getting frustrated too. Well, goodness, you know, I go to the gym, but I have to eat like a whole sandwich and a half a banana in order to go to the gym and not have a low blood sugar. What's the purpose of that when I'm trying to lose weight, and then

Scott Benner 21:30
I stopped doing it because

Jennifer Smith, CDE 21:31
and they stopped doing it right. Or on the other side of it, you know, someone who may actually, okay, I'm going to really focus in on my diet, I'm going to clean it up, I'm going to you know, cut my macros down and actually meet the caloric need that I'm at right now. And then what they end up with many times are lows, especially the cleaner the diet gets, and the more accurate intake of calorie value is for that person, your insulin needs will actually come down sooner. So to avoid lows and needing to treat in the time period where you're really trying to be Let's be good, let's say right, just take your insulin doses down by maybe even it's just your basil, take it down by maybe five to 10% across the board.

Scott Benner 22:17
Okay? So it's get your insulin, right. So it's understand diabetes first. And then it's the normal stuff, we all talk about it being active, getting your heart rate up. A sedentary lifestyle leads to more resistant blood sugars, which leads to more insulin, which probably leads to more lows, because you get out of balance, blood sugars, and what you just said, about clean eating. We don't really talk about it like we like if we were all out in a field, okay, let's say if it was 400 years ago, and somehow insulin existed, but we were still just farming and breakfast might be an apple you found on the ground, and maybe on Wednesday, if you're lucky. The guy up the street kills an elk. And we get a steak right? Like if we were still eating like that, and we had manmade insulin, people would not be using nearly as much as long as they use now, Jenny?

Jennifer Smith, CDE 23:14
Oh, no, not at all. I mean, if you were living on like, berries that you picked along the trail that you were tracking the elk on and then you stopped and you ate some of the watercress. Hey, get your vitamin C out of the like stream that floated by whatever. No, what No,

Unknown Speaker 23:33
you might not need as much insulin right?

Jennifer Smith, CDE 23:34
No, you wouldn't. You're also active level that I mean most like let's call them you know, cave dwellers or whatever at that point of life, right? activity was part of your day. They didn't have a gym that they went to. Their hunt for the bison man was like, act.

Scott Benner 23:53
I bet you're running from a mountain lion burns carbs. What do you think? What do you think? So I guess my point is, is that while I'm not telling anybody how to eat, and I'm not certainly telling you that my daughter's counting macros or anything like that. Processed foods, right? manmade foods, stuff that comes in bags, oils that don't belong in your body, all the stuff that we consume all the time that we're not aware of. It's making your variability greater and it's making it more difficult for you to use insulin

Jennifer Smith, CDE 24:24
true in fact, I've also kind of heard people and there's truth to it.

Scott Benner 24:39
Hey, let's not let's not waste any time shall we? just did it nice. How I said let's not waste any time it took me 10 seconds to say let's not waste any time then I went over it for 10 more seconds. I better jump in. Get yourself a Dexcom g six continuous glucose monitor why you'll be able to see trends, directions impacts of insulin on blood sugars, impacts of food on blood sugars, the impacts of life on type one diabetes, you'll see it all with your Dexcom g six continuous glucose monitor. And how does it do that? Well, it shows you your blood sugar in real time, not just the number, but the speed and direction of your blood sugar. Are you 184 and dropping or rising or stable? That's a big deal, isn't it? Because in each of those three situations, you might do something different. A rising blood sugar might get some insulin, falling blood sugar might warrant you paying attention to it, and say it's super stable, right where you want it, you know, you've done the right thing. The Dexcom g six gives that feedback in real time in ways that is so usable, you hear us talk about it all the time on the podcast. So check it out. dexcom.com, forward slash juicebox. Sure, there's alarms, you can set, those are a big deal, too. You can say, I'd like to know if I'm going below 80. Or if I'm going above 140. And it'll tell you don't want to know till you're 160, you can change that, that's up to you. The Dexcom g six is a vital tool. If you're using insulin, I'm talking about type one or type two, check it out, support the podcast when you do use the links in your show notes. Or type in dexcom.com forward slash juicebox. After that, you're gonna want an insulin pump. Right? Maybe you don't have one and you want one, I say check out the Omni pod, you have a different pump. And you're a little sick of the tubing. I say check out the Omni pod. You use an MDI giving yourself the shots and you're kind of sick of it. You know what I say? Check out the Omni pod, do that Omni pod.com forward slash juice box, you have two options when you get there. You can see if you're eligible for a free 30 day trial of the Omni pod dash system. And I mean 30 days is like a long time. And it's free. Or ask for a free no obligation demo pod where on the pod will just send you out one nonworking pod. So you can try it on and see what you think there's a lot of options when you get to that link. All of them are going to give you more information and help you make a good decision. On the pod.com forward slash juice box, use an insulin pump that doesn't have tubing that doesn't need to be taken off when you shower, or run or kick a ball. an insulin pump it doesn't have something on it along to from an infusion set back to a controller that can get caught on a doorknob or just kind of be a pain to carry around. When you like to carry nothing, just have that little pod on that talks wirelessly to a device where you give yourself insulin, not something that's tethered to you with tubing full of insulin. And they if you don't want it on the pod, whatever, do the trial, say you don't like it, don't like it. Nobody's holding you up, can do whatever you want, but at least then you'll have real data to make decisions with. As you know, I think data is very important. Okay, that's it on the pod.com forward slash juice box dexcom.com forward slash juice box links in the show notes links at Juicebox podcast.com. And again, if you're looking for these diabetes pro tip episodes, you can find them they started Episode 210 in your podcast player, where they're available at diabetes, pro tip calm and Juicebox Podcast comm

Jennifer Smith, CDE 28:38
many people have found that if they eat a true cart, let's say they eat an apple and they Bolus for it, they end up with the ratio that they're using for that simple, like very clean carb to go low. Okay, and then when they mix it up, and let's say they have potato chips or something along with the apple or they have something, you know, more processed along with it, their carb count ends up looking clean, like okay, it comes out I don't get low later. So what gives it really is that the body processes more natural food in a better way. There's there's less left over to kind of linger in impact. And a lot of people are basing their insulin to carb ratios, more specifically, around combination meals that are not quite as for lack of a better term clean,

Scott Benner 29:36
right. So your your heavier. Insulin ratios work better if you have the orange with the potato chips, but if you just eat the orange, the orange doesn't need as much insulin so the ratios you have or too heavy. Correct. I now Arden's ratios are heavier because she doesn't you know she eats a diet that has processed foods mixed into it, but she'll go on a kick around this time. If you're about oranges, where I have to buy like 10 pound bags of oranges to keep around the house, and she's like, I want an orange I want like now these are big like softball size oranges that I'm going to

Jennifer Smith, CDE 30:10
cara, Cara oranges. Those are my fav.

Scott Benner 30:12
Yeah, I think they are and they're really good, right? And but I bet you I've never looked, but I bet you that the carb count on them's got to be more like 25 or something like that, like he could be more, right. But I only give her enough insulin for like 11 carbs. And and she does a little 130 rise and comes back again. Because I you know, because I know her ratio is higher to handle other things, which is why you look at plates and go Okay, tonight, I don't need as much, you know, for right. But this is not this is not going to be a satisfying, you know, people just want to hear like, please just tell me what to do. And I'll do it right. So work, but nobody wants to hear. I guess this? I know, I don't like it. You know what I mean? I don't have diabetes, and I'm listening. I was like, Oh, this is how I would lose weight. So you know, it's, um, it's just, do you think that we've just spent so much time as a society looking for marketable sellable ideas about how to get around? The idea of being in shape? There's no, it's, it's exercise and calories. Right.

Jennifer Smith, CDE 31:21
And I think that's the reason that there are so many, I mean, if you look at around the first of the year, there, I can't remember which publication it is. But they come out with an analysis of I think, like the top most, or maybe it's the 25, top most like us call them diets, right, in the past year, and what's kind of proven true to what it promotes and what really isn't, it's kind of like flimsy, right? Um, and some of the top ones are things like the Mediterranean diet. And you know, by no means am I promoting that, or whatever. I'm just saying that that ends up being taught from a lot of different health parameters. And it's also a clean way of eating. Most people think Mediterranean and they think well, lots of breads and lots of starchy things. And that's actually not true. A lot of it is plants, especially the really good non starchy vegetable types of plants. And then if there are grains that are hardier grains, right? I mean, it doesn't tell you to eat your carbs as a bag of Doritos. It tells you to go and eat some keen Wah On your salad with, you know, an orange on the side. Right. But I think it brings in diets. Yeah, this idea that there is the perfect thing out there.

Scott Benner 32:43
Right, right, and that it's going to be doable for somebody because maybe, listen, maybe macro counting, maybe there's a biologist somewhere that could give you the perfect diet for your body. But where am I getting that from? And where are most people getting that I have to tell you that a couple of weeks ago, I started getting an ad, right. And then I looked in the mirror and I was like, My face looks puffy. And I went to the Costco and I bought two little roaster, chickens, and four steaks. I spoke them all, slice them up, put them in the refrigerator, and I've been eating those and salads and some of those oranges because they're around the house. for about the past eight or nine days, I'm easily 10 pounds lighter than I was. And I know that I know, I'm a fluctuating person. Like I know I jumped around like because what'll happen is at some point, someone's going to give me a piece of bread and I'm going to pick Oh my god, bread does everyone remember Fred? And then I'm going to eat a lot of bread for a week and I'm going to go Oh, now my back's deaf. And I feel like I gained five pounds and all that stuff. But just if I explained to you that most of my meals have been like a couple of eggs in the morning, and a couple of tiny slices off of that steak and then at lunch, some some of the chicken and some of the steak with a salad. And I've I feel great and I know it's true, because I've been through it enough now now to talk my stupid childish inside into like just continuing on that way that I don't know if I'm ever gonna get to do but I do know it's honest. And it works for me. And I've seen it work for other people too. Like you take out processed food and carbs. And your your you're better off like I don't know, it just seems obvious. But

Jennifer Smith, CDE 34:16
it's, it's you know, like you said you're not focusing on like macros. You're not focusing on how many do I need in a day? You're what we end up finding and I think this is the premise behind a lot of the like, the Palio kind of diet and the keto type of diet, right. It's, if you're following the rules of those plans pretty well. They can be very clean eating plan. They can. There can also just like being vegetarian can be or vegan can be very healthy way of eating, but they're also like the complete like backside of that where you're eating a lot of processed vegan or like the key You know, like kinds of things that are like the treats and whatnot, you're focusing your intake on a lot of that kind of stuff, you're lacking in quality. And then your macros may very well without you realizing it be completely out of order. And I think that's why a lot of like plans like this end up failing, you know, I followed keto. And it was supposed to be this magic, like weight loss, and I also have diabetes, and it was really supposed to help with my blood sugar management and whatnot, well, I haven't lost any weight, well, maybe there are some things then to evaluate within it, you know, the keto diet is a way to get your body to start utilizing fat instead of carbs. So if you haven't really analyzed how you've broken that down to make sure that you are one maintaining ketosis in the right way. And that the kinds of like carbs that you're eating are really not offsetting, then it may not work well for you,

Scott Benner 36:03
don't you find that you have to be in tune with what your what satisfies your body? Like Not, not what satisfies your brain, right? But what satisfies your body. And I've absolutely, I've seen myself go either way, like where you're just eating for taste and flavor and comfort. And that's never usually good for your body. And then there's a way where you're just sort of never hungry. It's it's that's where I am this week, I have not been hungry this week. And if I had any like inkling towards a sweet, I've been specifically careful to take just like dark chocolate, like just a little bit of dark chocolate like this will this will get me through, like, what I'm assuming is basically withdrawals from flour and sugar and stuff like that, you know? So I don't know, like, are you telling? He's telling me that all these questions aren't even worth looking at? Or should we ask them? No, I

Jennifer Smith, CDE 36:53
think they're very worth looking at, because I think some of them may relate to what we've kind of already gotten into. And then some of them, I think, are really good questions in terms of the why it wouldn't be working. Right what's or why it might actually work. So yeah, let's

Scott Benner 37:12
pick a favorite or should I just pick, you just pick right? Well, so Jennifer's asking about her son, she says any any advice on how to balance all this high carb gluten free food from my growing always hungry, 14 year old T one D with celiac. So she has a son who seems to need blending down and at the same time. She's giving him a lot of carb heavy stuff, because it's like it's some of this. For the celiac diet, it seems like right? The gluten stuff,

Jennifer Smith, CDE 37:43
right? And that's it. I mean, celiac is a hard addition. It definitely is because while we now have a plethora of gluten free, very tasty products on the market, most of them are made with very, very processed very high glycaemic, I mean higher glycaemic than even your wheat based bread, you know, type of pasta, whatever it might be. So when you start processing things, like rice into a flower, or, you know, potato into a flower, you have a quicker digestive component to that, and it raises the blood sugar faster, its glycemic index is just high comparatively. So when you have to do these types of things, especially if you have a teen who is growing, is active, but also could maybe use some slimming down, or maybe needs to gain a bit of weight. One, it's may be sitting down honestly, with a dietitian to see what are my child's growing nutrition needs right now? Are we you know, keeping kind of a log a couple of days of what are they really in taking? And then looking at what their nutrition needs should be for the point in life where they are, you know, are they moderately active? Are they heavily active? Are they kind of couch potato video gamers? What is it and what do they need? And then looking at the kind of food that you put into their caloric need, right, again, I mean, parents are typically the purchasers of the food in the house. Yeah,

Unknown Speaker 39:27
give or take. You don't think this 14 year olds got a credit card?

Jennifer Smith, CDE 39:30
Yeah, no, I mean, and my kids, gosh, I mean, if we walk down the aisles in a grocery store, and they see like, the pretty packages and you know, like, I never got we don't eat cereal, so I don't go down the cereal aisle, but they'll always have something on like an end cap, you know, at the grocery, especially my eight year old, like, boy, that looks really good mom. I'm like yeah, and not really good for your body.

Scott Benner 39:56
That's why they have to make the picture. So nice. Right? There's no fun here, stop it.

Jennifer Smith, CDE 40:04
Well, so I think, you know, from from that standpoint, you have to look at what is the child in need of? Are you meeting it? are you creating access? And then potentially from a gluten free standpoint? Yeah, finding substitutions that can be fit in to meet his tastes, because all kids and teens are different, you know, as much as you want them to eat asparagus, they might not. Yeah, so you know,

Scott Benner 40:29
right. So, so you have to be, it's Listen, I know, if you've been listening for a while, you know that I took me a while to diagnose my low iron thing years ago. And during that a doctor made me eat like, gluten free for a month, and I gained a lot of weight because I went out and bought all these gluten free items. And somehow in my mind, I was like gluten free equals health. That's how it felt to me. So I was like, oh, it felt like zero calorie stuff when I was going in. And man, it was just not. I think if this was me, if Jennifer was me, and I didn't know what I was doing, I think I'd introduce, like, lower carb, more meat friendly, like meals, like that's what would occur to me first, right? Make some chicken, make some steak, put it with a salad or a vegetable, and maybe cut down on carbs. But then you got to remember, like we spoke about earlier, not to dose it as harshly as you would some of this gluten free stuff, or you're just going to create a low and you're and then have what you did buy with them. Right?

Jennifer Smith, CDE 41:27
And I think you know, when we look at, you know, going back to just that, like clean eating idea, quite honestly, you can be gluten free. If you're choosing to not buy as much processed food pretty easily. Yeah, I mean, you know, things like qinhuai, or, like a wild rice, or even like a brown rice, or what, that's 100% gluten free.

Scott Benner 41:52
It's the fun stuff where it causes your problem,

Jennifer Smith, CDE 41:55
right, it's not taking it out of the diet, it's just that you know, and I know the struggle with kids, I work with plenty kids and teens to know that what they get at home, under mom and dad influence because this is what you're eating turns around, it changes considerably once they start to do things with their friends, you know, now gluten free in the picture. If the child is paying attention to that, and knows that they just can't have gluten, they may already then have limitations, even compared to what their friends are eating, because they know that they just can't do it, or they're not going to feel good, right? But in that circumstance, then it kind of takes sitting down and figuring out well what that what will possibly be there that you could have, um, knowing that it's still more of like a process Trini kind of thing, but also that, you know, we're not going to do this at home. But you could have it when you're out.

Scott Benner 42:54
Okay. Laura has a question. It says, Is it true that insulin on board prevents the body from breaking down fat? Meaning that in order to burn fat, you need to have stretches of time with only your Basal insulin and no insulin on board? That's interesting. I've never heard that.

Jennifer Smith, CDE 43:11
Yeah, it is, I guess it's an interesting way to frame it. I mean, we know that in the we know that in the overnight time period, without any food on board. And on basil, only. Our body does get into more of that, like fasting state, right, of actually transitioning to some fat burn, etc. Because you're on a low level of insulin.

Unknown Speaker 43:34
I see what you're saying. Okay.

Jennifer Smith, CDE 43:36
But when you have insulin on board, technically, there's a reason for the insulin on board. Right? Right. You're dosing for food, so that insulin on board should be covering food that is there. So yes, your body's processing carbohydrates. And your body is not at that point then going to be in fat burn mode. It's kind of correct in a way of stating it. Yes. I mean, the same thing for a high blood sugar that you've corrected. Now you've got iob. And the high blood sugar indicates that there's excessive sugar there, and your body needs to process it. And as such, it's using the insulin to process it and break it down and get it in the right places. So again, technically, as long as there's not an insulin deficit in that high blood sugar scenario, and insulin is working to get it down then your body isn't also breaking down fats either. Then is that a vote for intermittent fasting for type ones? It could be and can intermittent fasting work, right? It can. But again, a blanket statement is to stay that any plan that you choose. No longer term that you can continue this, right? The problem with the diets that are out there isn't the diet itself. In fact, there's a lot of research around a lot of the diets that proves long term, these people have had this success in weight management and cardiovascular benefit, etc, etc. But they've stuck with it. Yeah, it is the Oh, I'm going to do intermittent fasting, oh, I'm going to do the keto diet, oh, I'm going to do the, you know, cabbage soup diet for the next month. And once it starts kind of showing benefit, I'm like, I can do I can kind of step outside of the rules, parameters, which are often for diets very black and white. Yes, do this, this and this, but don't do this. And as soon as you do that, don't do this. You've broken the piece of that plan. That was getting you to your goal,

Scott Benner 45:52
right. I found intermittent fasting, the easiest to stick with, because to me what it was was as long as I don't eat, like don't eat after ate, and don't eat before noon. That is basically how I did it. And I have to admit, it's very effective. Now, I realized while I was doing it, that Arden basically does that already, without the late night thing. But she's so young, I don't think it matters, right. But she gets up in the morning and is not normally hungry in the morning. And so I've had to over time thoughtfully balance out how her insulin works in the morning, right? How do I come out of sleep into feet on the floor, off to school without a rise that needs a bunch of insulin so that I don't create a low because she really doesn't want to eat until she's done with school or till lunchtime, right? Sure. So basically, Arden does intermittent fast, except she doesn't do 16 is it 16 wait 1819 2016 eight, that was embarrassing. A lot of people would edit that out, but I'm not going to. She doesn't do 16 eight and as much as she probably does, like, maybe 1410 something like that. But also she's 16 so she can write you know, she can like we over Bolus her meal last night for dinner. We had stuffed peppers, like Turkey stuffed peppers, and, and a salad. And my wife, my wife, like swung at it really hard. And about a half hour after she ate I was like, Hey, your blood sugar is like stuck at seven. I was like I This doesn't look okay to me. Like I think this is gonna go the wrong way. You know. And so as it started to trend away, Arden got a little light in her eye and she goes cinnamon toast crunch, please. So she knew she had basically Pre-Bolus cereals. So she was like, let's do it. And she had some of that have my wife go on. I'm gonna guess 10 or 15 carbs less on the Bolus. She hit it right on she was so close. But But you know, that's a young kid. And Arden's also helped by other things that I think are worth mentioning here too. Because those of you listening have type one diabetes, or love somebody who does, you really have to get your thyroid levels checked. Like you could be fighting against a borderline thyroid problem that's making weight loss impossible. You know, and you if you're going to do that you really need to go back and listen to the thyroid episode with Dr. Benito because the range that your doctor is gonna say your thyroid your TSH levels, okay, and a real badass endocrinologist will not accept you know, they mean they will not like if you're over a two Doctor beanitos giving you thyroid hormone like and there are people right now we're listening. You're like oh, my TSH is a five my doctor said it's okay. I'm borderline. Yeah, yeah, right. But I but my hair does fall out a little bit or I'm having trouble losing weight or I'm a little nasty sometimes or whatever the other things come. But I'm just telling you if your thyroids moving the wrong way, deal with it, because it makes a lot of life easier.

Jennifer Smith, CDE 48:56
And it's a lot within this whole topic of weight management. Absolutely. If you've the Hashi moto is which is very common autoimmune. Once you've got you know, type one, it's good to get tested thyroid levels at least once a year if not every six months, especially if you've got other family who has a thyroid disorder known already. But that's huge in terms of metabolic

Scott Benner 49:20
Yeah, but you have to you have to advocate for yourself. You can't say oh my god, Scott, you're right. I am tired all the time and I can't lose weight and blah blah blah, and then go to the doctor and the doctor say Oh your TSH is four you're fine your TSH just for you are not fine. That's the equivalent That to me is the thyroid equivalent of in diabetes. When somebody says yeah, your blood sugar, your average blood sugar is 180 You're doing great. Right? Right. You might you know you're not dying, but you you're not living at a healthy level. And that has other impacts on your life. This thyroid thing is it is crazy. It is like the equivalent you trust me at this point. I've seen everyone in my family except for me deal with it. It's like taking a long metal like paper. clip and just touching it on a computer circuit board. It just messes with stuff, you know what I mean? Yeah, but,

Jennifer Smith, CDE 50:06
and with with Ardennes doses, have you noticed that when things get out of order, do you notice a shift in her insulin need, because that's very common right away that, you know, metabolically, she's feeling more sluggish, sluggish and fatigued. And insulin is just not working, like it was supposed to work. And if there's a timeframe in terms of adjustment, or even just starting on a thyroid medication, where you will then start to notice a shift back to normal insulin dosing. See, again, that insulin manipulation in terms of the weight management piece with thyroid in the picture, you have to be very kind of eyes on right to make sure that you're adjusting then where you had bumped everything up in terms of insulin need, you're going to need to start bumping down. And if there's weight loss in the picture at the same time, definite need to bump down or you're gonna just run lows. Yeah,

Scott Benner 51:01
I there's something I use, I think I should even have a flowchart for myself like If This Then That kind of chart because you're right. If the thyroid level starts to get away, then her insulin needs go up. And then we adjusted, it doesn't happen right away, and our insulin needs start coming back down again, the same thing with she had to start a birth control pill to regulate her periods. Hall. I lost three months of my life to figuring that out. Like it was just first they gave her a pill with not enough estrogen in it. So it was basically just two wasted months. She was exhausted all the time because she was bleeding constantly. So I had to get her through those pills. Those aren't the right pills put her on the right pill that started working the bleeding, regulated. Yay. Now she's lost so much blood, I had to go get her an iron infusion. Got her the iron infusion. Now we're waiting for that to come back up. When the iron infusion comes on board, her insulin needs are gonna change again. Yeah, vitamin D levels seem to impact insulin knee. Yes.

I just,

Jennifer Smith, CDE 52:05
in fact, many people for vitamin D that you bring it up. That's another like piece. And I think in terms of like, like, again, going down the rabbit hole of discussion and weight management, the we're kind of on the track of like medications, and medications in terms of thyroid, as well as things like iron. But vitamin D, you know, your lab will tell you optimal is between or standard is 30 to 100 optimal according to the female specific physician that I'd worked with years ago, before I had my first son, she was like, you know, optimal range is really 50 to 70. For vitamin D, she's like, and if it is not in there, you need to be being supplemented, because otherwise, especially with diabetes, vitamin D works on the cellular level. And it allows insulin to be seen correctly, it for lack of a better term by the cells. And so it lets insulin actually work the way that it's meant to have one of the many things that can so if your vitamin D level is off, supplement, I mean, in general, someone with type one, adult wise, should be supplementing at least 2000 I use a day. And if your levels are not optimized at least 4000 a day. And if they're really on the low end, you need to be doing like the hyper significant doses of vitamin D for a short period of time, if you

Scott Benner 53:30
like. And then for 50,000, I use and you take one once a week or something like

Jennifer Smith, CDE 53:34
once a week, or I've even seen some doctors do like 110 1000 iu a day for you know, a couple of weeks and then retest. But vitamin D is huge.

Scott Benner 53:43
And I'm not a doctor, but there's something about vitamin D deficiency and autoimmune that go hand in hand. So just look

Jennifer Smith, CDE 53:50
at the studies out of Finland,

Scott Benner 53:52
right? I listen, I take 5000 a day. And I take 5000 a day of vitamin D, I take a zinc tablet, I taken a sorbic acid with iron and a B 12. And that's that's what I do every day. And that's what you know, my kids do and and everyone here is doing because when the D levels drop again, problems with insulin, I'll tell you right now too, because Jenny mentioned ranges that you need to be in versus what lab values will tell you, Dr. Benito back on the thyroid things that if you were a woman of childbearing years, anything under 74, your ferritin is too low. And they're not going to tell you you're low till 20. So she's like if you are having a period, he gotta be above 70. And so there's a lot of things. And then all of these things also impact your body's ability to work correctly, which is in part and parcel of losing weight or

Jennifer Smith, CDE 54:50
losing weight, right. There was one in here that does go along with medications that I think is a really important question. This woman has a son on a medication that is more for like attention. And it's specific to using it versus not using it school year versus spring date break or summer time and what ends up happening in terms of insulin needs. And I think it's an important one, because I've seen a lot of kids who are using a DD ADHD kinds of meds. And a very, very common thing with those is that it decreases appetite. Okay. And if they're using it in their school day, and they're also the brain uses carbs. And so the more thinking that's going on, and the potential that they're really not hungry, they may not even finish the lunch that you packed for them, they may pick at the lunch that comes from the school lunch, because their brain is just saying, I'm not hungry enough to eat, you may end up having to have two types of basil profiles, maybe one for like a spring break, time off another one for school days. And again, as kids get more into the teen years, that becomes really beneficial in terms of growth and the potential for weight gain in the wrong direction. Because if you're constantly feeding loads again, or constantly adjusting insulin up and down, but it's kind of willy nilly and not quite right on with need. It's a medication adjustment kind of thing that goes along with adjusting insulin

Scott Benner 56:31
again. We're right up on it. But there's enough questions in here that all circle around menopause. Do you have any feelings about what happens at that time? And

Unknown Speaker 56:41
yeah,

Unknown Speaker 56:42
that's a fun one.

Jennifer Smith, CDE 56:45
I mean, in general menopause in and of itself. I mean, perimenopause really is the start of kind of that time period in a woman's life where your cycles might start to get less evenly spaced, right, let's say you were the typical, like, 29 days, and you was right on spot. And now like, Huh, now it's like 26 days and next month, and might be 32 days, and that may be 29 days. And, you know, periods can get a little bit more aggressive, or kind of look more spotty. But that perimenopause kind of leading into menopause, which is really, a woman has not had a cycle in a 12 month time period. Right. So insulin needs can look very jumpy, you might even find that, again, as we get older. And these things come into the picture from a female perspective, our metabolism does slow down, we oftentimes start to need a little bit more insulin, or it takes a little bit more activity to maintain or burn off what we were able to do when we were 30. That doesn't work anymore when you're 45 or 50. So a menopause, perimenopause, it brings in a whole circle of hormone impact, right, that may more aggressively change your insulin needs, especially around your cycle times.

Scott Benner 58:10
So not unlike, well, I guess, more aggressive but not unlike having your period and seeing right hormone fluctuations throughout the month,

Jennifer Smith, CDE 58:19
right. And then once you're in menopause, oftentimes, you know, outwards of a year or two post no longer having a cycle. Many times, then insulin levels should get more stable, because you don't have that hormone flux. And as we age men and women have less and less and less growth hormone cycling anyway. And so we end up especially women passed about the age of 65, or people passed about the age of 65. Oftentimes, their baseline Basal needs definitely go down. And the reason there is because their hormone cycling has kind of started dropping off. Okay.

Scott Benner 59:01
All right. Did we do this justice in an hour? Because I feel like we did, but I don't know much.

Jennifer Smith, CDE 59:06
I think that we did as much as we could get it in an hour. I mean, if we really wanted to focus in again, dig really deep into that information hole. There's a whole bunch about meds that are very specific to like weight loss, and you know, things like the GLP ones and things like the stlt tos and what despite them being type two meds, they are getting a lot more. They're kind of climbing on the ladder of benefit for those with type one and who are just insulin users. And they do have promise in terms of weight management, if use the correct way.

Unknown Speaker 59:51
Okay, so

Scott Benner 59:53
do you feel comfortable talking about that? Because maybe you say here that if you like this episode, look for that one coming in? Yeah. Okay. Great, thank you. Yeah, Jenny, you have to do all the talking. I was at some points. uncomfortable. Not for because he was like, Huh, there's not a lot for me to do here. I was just checking. I was just saving files and checking rates and looking at questions I

Jennifer Smith, CDE 1:00:18
was like, so like, I should have just gone and gotten an extra cup of tea.

Scott Benner 1:00:21
kind of nice. I should have just said, Jenny, tell me about weight loss. I'll be back.

Jennifer Smith, CDE 1:00:26
Really is I was looking at all the questions. I mean, there are a lot of really good questions, but I think a lot of them honestly. Go back to insulin. Yeah. dosing it the right way for what you're kind of taking in. And then also, secondly, looking at what are you taking in,

Scott Benner 1:00:45
right? And obviously, in my mind, these questions all are, they're similar, they're tied together, whether it's vitamins, or your thyroid level, or your calories or, or whatever it ends up being, there is a balance that optimizes your body, it's not going to be the same for everybody, some people's vitamin D level can be crashy load to the floor, and they'll never notice it, and it won't matter to them. But for some people it does. And when you get those things in the right balance, then you feel better and feeling better. To me, as you feel stronger, you're more rested, like all this stuff happens. You're clear in your mind. But how. But some of these things nobody would even know to look into. No, you know, even vitamin D like I can remember 10 years ago, my ardens nurse practitioner gone, we're gonna start checking vitamin D was almost like a mandate came down from a mountain, you know what I mean?

Jennifer Smith, CDE 1:01:35
Yeah, actually, I don't even know when that would have been. But if it wasn't, I remember when I was working in DC, and the endo practice I worked with within the, our director was very, like high up within the whole, like, diabetes management, like realm of information. And his he was like, we are testing vitamin D levels for every person with diabetes. And at that point, it was really just, if the thought was it was relevant more to type two. But as we started testing, then I went to my own end to when I was like, you know, I run I'm outside all the time. I have, like, you know, like brown skin from being outside. Like, I don't take my, I'm like, I'm sure it's fine. In fact, my vitamin D level came back and my doctor himself called me, not his nurse. He was like, this is really weird. But he's like, I want you to go and get it tested again. He's like, this can't be right. And my level was 18. Yeah. 18. And so when it got to test again, nope, it was 18. Again, he was like he did he that was the one time a week the 50,000 I use, I came back in eight weeks, it had moved to 21. And he was like, Huh, so I he sent me to see like a naturopath, who was also a physician who knew a little bit more in that realm. And she actually had me started, she started me on oral drops, okay, and the drops get absorbed through your oral mucosa rather than having to go through your gut. And because we know there's a lot in terms of gut and absorption in autoimmune disorders, she's like, I guarantee your body's not absorbing it. She said that's the problem. And is within about I think it was 10 weeks after that I got it retested and was already up in the high 40s. Yeah,

Scott Benner 1:03:25
you know, I have to, I thought I was gonna have to live getting iron infusions my whole life, because I couldn't absorb it through my gut. And I do probably have some like weird stuff going on down there. And instead, I mix it. So first of all, I use a really pure like supplement from a company that you know, you can do your own research and find one that you like for yourself, but I researched out found a really pure supplement. And I have to take the iron within a sorbic acid at the same time. I do that it absorbs great if I take just the iron tablet without the sorbic acid won't won't work. Yeah, that's it. There's a over the counter when called via Tron or by Tron D or something like that. It's it's iron that comes with it. C, Vitamin C. Okay, gather that helps that too. But yeah, these are the kinds of things no one's going to tell you about. Or they're just gonna blurt out. We're testing for vitamin D Now, then you come back, quote, unquote, in range, and they don't give you one anyway. And you're like, wow, this was a lot of fun. So anyway, everybody balanced your body, balance your insulin. things should get better. That makes sense. All right. Thank you, Jenny.

Jennifer Smith, CDE 1:04:30
Yeah, you're welcome. Absolutely.

Scott Benner 1:04:38
Let me thank Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. I'd also of course like to thank Jenny, you know, Jenny works for integrated diabetes. So if you want to learn more about what she does for a living, you could even hire her. You go to integrated diabetes comm I think there's even a link in the show notes to email Jenny, but I don't remember I haven't looked in a while. You'll find out, just go route around, see what you can say? Would you like to see if you're eligible for a free 30 day trial of the Omni pod dash, go to Omni pod.com forward slash juice box. And of course, to learn more about the Dexcom g six and to get started, it's dexcom.com forward slash juice box there are links in your show notes, links at Juicebox Podcast comm or you can just type those right into a browser. Since we're at the end, and you're still here, let me tell you a little more about the diabetes pro tip series. First, I'm going to read you a couple of reviews, all from Apple podcasts, this podcast that changed my life, I had a desire to lower my agency and manage my blood sugar's better, but was going at it blindly finding this podcast put everything into a tangible and practical management approach that is taken my agency from 8.3 to 6.3 in less than six months. And that's just right now, it's going to keep coming down. Thank you, Scott, I'll be quoting you forever. My son was diagnosed with type one about five months ago. And I've learned so much from just the pro tip shows and we'll be listening to all of the episodes. This podcast is amazing both for the information and for the shared experiences from Scott and his guests that make you feel less like you just got hit in the face with a shovel. And more like you can find ways of keeping your loved ones happy and healthy. And finally, I saw I mentioned this podcast and one of the Dexcom g six groups on Facebook. The pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years. I wish I had been more proactive in finding the information sooner. I'm going to recommend this to my endocrinologist. So that's a little bit about the diabetes pro tip series and the podcast from other people. You can just subscribe right now in a podcast player just hit subscribe if you're there, and you can listen to the podcast every week, three new episodes every week. If you don't know how to find a podcast player, there's tons of links to free ones at Juicebox Podcast comm where if you want to start with those diabetes pro tip episodes, or in my opinion, I like seeing you start with the defining diabetes episodes which are much shorter, and give you a good basis for all the terminology means and how to use it. All that information is at diabetes pro tip comm you can get there just by typing that into a browser. Or if you go to Juicebox Podcast comm there are links to the top one of those links as diabetes pro tip. start listening. I mean, wouldn't you love to send a review and that says my agency went from eight three to six three in less than six months would be amazing. So I hope you keep listening. I hope you enjoy the podcast. Thank you so much for checking out this episode. Please share the podcast with a friend. And don't forget to subscribe. Thank you so much. I'll be back soon with more episodes of the Juicebox Podcast.

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