#560 Diabetes Variables: Sleep

October 15, 2021Scott Benner

Diabetes Variables: Sleep

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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Scott Benner 0:00
This is Episode 560 of the Juicebox Podcast. I am. I'm impressed with myself if you all knew me personally, you would be amazed that I've done this, honestly, that I didn't like, you know, get like five minutes into it was like it was a lot of work. Oddly not like me, but maybe it is now. Who knows, live learn, right? Grow change, etc.

Friends Today I'm back with another episode of the diabetes variable series with Jenny Smith. Today's topic, as you saw in your podcast player is sleep, Jenny and I will talk all about sleep and how that is a variable for your type one diabetes management. While we're doing that, you'll remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And further, you'll remember to consult a physician before making any changes to your health care plan, or becoming bold with insulin. Jenny Smith is a guest on the podcast but she has a real job at integrated diabetes comm where she helps people with their diabetes in exchange for funds and goods as capitalism works. Integrated diabetes.com ask for Jenny. Now that I'm thinking about what I just said, I don't think you can exchange goods for services with Jenny. But I mean you could ask offer a sofa, see if she'll help you with your Basal insulin. Are you a US citizen who has type one diabetes or a US citizen who is the caregiver of someone with type one, please if you are, go to T one d exchange.org forward slash juicebox take the quick survey help the podcast help people living with Type One Diabetes. I want to put the ad right here because I don't like splitting up shorter episodes. But that's not what Contour Next One paid for. But I feel like they'd be okay with it if you guys promise just to listen to the ad, okay. All right, you promise to listen. And I'll do this so that you get an interrupt an inner, inner inner I was gonna say an interrupted, I meant an uninterrupted episode. with Jenny and I know this is this. It's a clunky start. But watch how I finish the Contour. Next One blood glucose meter is top shelf to understand it is super duper accurate, incredibly easy to use, and easy to hold and transport. This means if it's in your pocket, if it's in your purse, anywhere you need to keep your gear, the Contour Next One slides right in and doesn't get in the way. It also has an incredibly bright light for you know, when you're sleeping, and it's dark. room it lights up like thing from a movie that we can't say because I think it's copyright infringement. And it allows the room to glow. It's as if heavenly light has shone down upon your finger. You strike it with a lance click, blood comes out. You take the Contour Next One meter, put in the strip, touch the strip to the blood. Oh, is it not enough blood, no big deal, this trip has a second chance to feature just get a little more blood, squeeze, squeeze, squeeze and go back and hit it again. You have not ruined the test trip by doing that. Or ruin the accuracy of the test. Second Chance test trips from the Contour Next One blood glucose meter. I mean, what will they think of next. Also, the screen is incredibly easy to read. And if you would like to pair your meter to a rockin who is sending me got text matches the middle of what? Hold on. Alright, I'm back. Sorry about that. If you want to pair the meter to an app Contour Next One has a really terrific app too. So you can use it with or without the app. Last thing I want to say is that well you know i want to say two last things. So last thing like let's call it one I want to say is that I'm always afraid that when I talk about Second Chance test strips that you'll think oh this thing must need so much blood but it doesn't it needs a very little bit it's not a big blood drop that you need. I'm just saying that if for some reason you don't get quite enough, you can go back and get more. Okay last part go to contour next comm forward slash juicebox there's like zero sincerely, I'm not just trying to drive you to a link What am I really want you to go to the link but that's not the point. There's a lot of information at the link. So if you really want understand all this Contour Next one.com forward slash juicebox and I'm just going to finish with this. There are a lot of you walking around with subpar meters. It's not necessary. You're already paying the money. You're paying the money for the meter, you're paying the money for the strips, you might as well get a good one Contour Next one.com forward slash juice box. Get yourself a blood glucose meter. That equals your effort. You're trying right you need good information back from your gear. Jenny Campbell Do sleep as a variable for managing insulin. I don't know, I don't have a lot of feeling about this, honestly, it's not one of the things that I've noticed. But maybe I'm not looking hard enough. And when people sent in variables for the list, sleep, sleep deprivation, getting good sleep versus getting bad sleep, like broken and unbroken. Everybody sent that in as a variable. So I don't understand why that would impact anything.

Jennifer Smith, CDE 5:35
Well, you know, overall, sleep provides a lot in terms of recovery, and build of like cellular sort of restructuring and whatnot in the overnight time period, right? That's, we're supposed to get these waves of light sleep, deep sleep, etc, that help our body to actually then recoup and be ready for another day. When it comes in terms of type one management, that's one of the biggest things that most people say is, I just want better sleep, the daytime, I can struggle through manage through if I've had good sleep overnight, I can deal with the daytime management. So from one, sleep deprivation can lead to poor overall management, because you don't have as much with all that we have to manage in today's world beyond our diabetes, that's another layer that we have to consider. And if you haven't slept well, you're not going to be thinking as clearly, right. on another level, though. There are a lot of different hormones that are regulated through the sleep cycle that have relation to appetite, and the turn on the turn off of appetite during the daytime. And so for someone, again, managing diabetes, if you are not sleeping well, it is very likely that some of those hormones that are supposed to be being managed for then transitioning into what you're craving, unable to manage in terms of your intake through the course of the day, those are not going to be regulated the right way either. So there's a lot to sleep, that does translate into diabetes management, right.

Scott Benner 7:31
So the one, the one thing that popped into my head, when I saw this as a variable was that I thought I for sure had heard that shift work could be bad for people in a way that I never expected that he could make you more, the way I looked it up it's a shift work can have an adverse effect on type two diabetes, it can also put a person at higher risk of developing type two type two in the first place shift work, particularly that involving overnight and varying shifts can make it more difficult to manage glucose levels. It doesn't it doesn't really go on but I really I just remembered hearing that that there's something about the is that this circadian rhythms, the

Jennifer Smith, CDE 8:12
circadian rhythm really. And I it's interesting, because I just attended the ADA scientific sessions with our virtual conference. But some of the sessions that I did attend were specific to the circadian rhythm, and sleep and appetite and weight management, which does relate to much more into type two. But it's also a realm of something that many people with type one try to manage really well to write. So in terms of what they found is those who had a much more stable daytime structured schedule, and they slept overnight, even if the sleep was not as good but they had their normal sleep time in the overnight time where typical circadian rhythm kind of is meant to be. They found that people had better weight management and had better glucose control. The other piece to it was that with shift work in the picture, schedules are often very disrupted with shift work. It's not often that people have consistent enough schedule with a shift like I think of many of the nurses that I've worked with, who have some shifts and some weeks that are an overnight shift, and then they've got several days off and then they go to a daytime shift, then they've got several days off and then they go back to like the evening or the overnight shift, right? That's a complete disruption to what your body is even trying to set as a some type of stables schedule. It just it doesn't happen. So in terms of like all management It's really hard to then get a grasp on insulin doses and or even use of medication. And food intake gets disrupted, now you're eating at two o'clock in the morning because that's technically your lunch hour went in four days from now, your lunch is going to be back at 12 or one o'clock. And I know

Scott Benner 10:19
I remember we've talked about that before, too, that that actually still impacts things like feet on the floor and stuff like that, too. Like if you wake up at three o'clock in the morning, suddenly that feet on the floor impact is happening at that time of the day. Absolutely all that other stuff that's really fascinating.

Jennifer Smith, CDE 10:34
I mean, I in terms of that, I even remember noticing that myself if I would get up overnight for more than just a tuck a kid back in bed and then go back to bed myself five minutes, I didn't get that impact. But if I was up with a foster child or for nursing overnight or something like that, and I was up for enough of a period of time, I definitely saw that happen when otherwise overnights were flat.

Scott Benner 11:00
You know, I was just thinking about you ever been like gotten sick or exhausted and you fall asleep in the middle of the day? And the sun's up? And you're in a deep sleep Lee, when does that happen? Back to had to have happened to at one point, and you wake up at seven o'clock at night. And it's dark. And it's the kind of dark where you're like, it could be midnight it could be 2am I don't know what time it is. And you can't it gives you that really horrible strange feeling of like you don't know where you are. It feels very disorienting, right? Yes. And the only time the only way to fix it is to go back to sleep and wake up with the sun again. Yeah, yeah, it's a I have it here just us is it circadian circadian circadian rhythm or circadian cycle is a natural internal process that regulates the sleep wake cycle and repeats roughly every 24 hours. It can refer to any process that originates with an organism, okay, we don't care about that part. But the other thing there. And the only way I can relate to this, and I've had someone on recently to talk about it, is that I am very steadfastly eating within a an intermittent fasting schedule, is really made a vast improvement on how I feel. You know, when I spoke to Jen Stevens about it on the podcast, she was talking about, you know, just pick a she talked about is in the eating window, not as like, she didn't think of it as fasting as much. And so I'm just pretty much sticking to an eight hour window. Yep. She told me if I take my window down to fewer hours, I'll start losing weight. And I haven't gotten to that part yet. I was waiting for the kids to go back to school. So we're getting up to that. Now I'm going to shorten the window up a little bit. But basically, basically, I'm not eating after the sun goes down. I'm 11 to seven ish. I'm trying to eat around in that situation. And one of the things she talked about is how, why does that work for people for weight loss, and she said it. it lessens your need for insulin. So your body goes through big portions of the day where you're not your body's not calling for insulin, like it's the opposite of the idea of like, eat small snacks all day long. She's like, I don't like that idea because your body is always using insulin. Now she was talking about, you know, people who don't have diabetes or type twos, how that could affect them. But then I realized Arden's a person who doesn't eat breakfast. So over like most of the time, like on a regular school day, so overall, Arden's eating in an intermittent fasting window. And she can fast with a stable blood sugar, like no one I've ever seen in my life. Like, you know, now that you're on the algorithm, and you can see it Arden, if Arden doesn't eat for 12 hours Arden's blood sugar is just he just is. And so I don't know that all those things fit together. But I think all the ideas fit in here somehow, you know, the idea of being on that cycle, and that your body works better in cycles, and that it needs time off and time to do things. I mean, I'm obviously no expert, but all that makes sense to me somehow.

Jennifer Smith, CDE 14:15
Yeah, absolutely. I mean, the, they're seeing their circadian rhythm, the hormone component and the overnight time period. I mean, they are all kind of tied in along with the intermittent fasting idea. In fact, one of the other ones that I listened into was all about, like those who did the best weight management wise, kind of from short term analysis to long term like a year out from having lost weight, and then what's the maintenance of that in terms of their ability to maintain and some of them were doing intermittent fasting, but they did it. I also don't really like the fasting component because you're fasting in a given time period, but you're not Really just not eating, right? I mean, people think of fasting as like 24 hours, you're just not eating anything really you just containing the time period. And they found that people that did intermittent fasting with breakfast being the bigger of the meal, lunch being a bit lighter and the last meal of that time period, especially when it's eaten, I think it was before, like 7pm did the best with overall loss, and then maintaining that loss, compared to people who just shifted that eating timeframe by about, I think it was a three hour chunk of time forward, and eight later into the evening, but still within a time block. That was an intermittent fasting, like I only eat within the six hour eight hour time period. So the later eating tended to increase the risk of gaining weight back and or just not losing as much weight, which was interesting to

Scott Benner 16:00
the reason I brought it all up is because if you're if you're sleeping on a pretty consistent schedule, then it makes sense that you'll be able to eat on a pretty consistent scale. Yes, right.

Jennifer Smith, CDE 16:10
Exactly.

Scott Benner 16:11
I and I mirror what you said in what I'm seeing that. First of all, it's easier to eat bigger in the beginning of the day, because you've come out of a window where you haven't eaten for a while. That is the time I am the hungry. It's like I don't want to you know, I don't I don't wake up like I haven't eaten yet. It's 1151. And I'm not hungry. So but I will go eat now when you and I are finished. Sure. And I will eat probably my larger meal of the day. Yeah,

Jennifer Smith, CDE 16:41
and it's in the day. Yeah, you're not putting it in the evening, when you're less likely to be up and moving and going about your business, you're not going to bed on a really full stomach that your body then has to do something, digestion specifically, in a time period that is not meant to be doing that, which

Scott Benner 16:58
I was gonna say can affect your sleep, which Yes, talking about and we've talked about it in a number of other episodes, leaves your body with a task of having to work on food, and digest food at a time when it's trying to take away that process to do other things. So yeah, you're basically asking your body to do something when it was getting ready to shut down that function and do other things. Right? So don't go to bed on a full stomach.

Jennifer Smith, CDE 17:24
Yes, yeah. That's it. Easy, easy statement to say harbor?

Scott Benner 17:32
Pizza much better and even. It's just obvious. Okay, um, can we do pump site placement? Sure. Alright. So it's always feels weird to start over when we do these strings. Because I come back to them and edit it. I hear myself go, Hey, Jenny, today, can we talk about pumps?

Jennifer Smith, CDE 18:02
We've really been talking for like, 45 minutes. We've been talking forever.

Scott Benner 18:05
We've done like a bunch of these like, and I feel silly. But anyway, hey, Jenny, can we talk about pump side placement today? Absolutely. Excellent. Yeah, we just leave all that in so people know why I'm laughing. So it doesn't matter, right? If it's injected, or pumps, there are just going to be places on a person's body that I don't know what to say, does it absorb the insulin better? Does it use the insulin more efficiently? Like how do we think about it?

Jennifer Smith, CDE 18:36
I think they're both kind of the right way to say it. Because honestly, underneath the skin, I mean, the goal is to have insulin absorb right and to get used in an efficient like, pattern of in, gets used goes out is finished working. I mean, many people on pumps, I think more than people using injections will start to notice places on their body that definitely absorb the best. And other places that they get good use out of, but they might actually have to have a secondary Basal profile that's notched up a little bit more, because they just don't quite meet the same glucose targets with the same basil from let's say, a stomach site versus a butt site or, you know, whatever it is. And then there are some people who can't use certain sites at all. I mean, I personally cannot use my leg. It just it just doesn't work for me. I either get occlusion alarms, or the sight hurts. And I've also noticed with that then it's just not getting absorbed. Back early enough, I guess is the easiest way to kind of explain it. It's it's much less consistent absorption there. So I just I just don't use my legs.

Scott Benner 20:09
Do you think that's because do you think there's a reason to point to do you have like a stronger leg? Is that muscular?

Jennifer Smith, CDE 20:15
For me? I truly believe it's because I just have pretty much just muscular legs. I mean, I've done biking and dance, and lots and lots of things over the years. And I continue to run and do yoga and bike and yeah, I think it's that now the interesting thing is that I can wear a sensor on my leg. No, I just can't put a pump site with insulin there.

Scott Benner 20:42
Okay, is there anything about like, I've heard people say over the years, and I've never understood if it was true, or not, like, I can't put my pump near like the, you know, muscle in my thigh or towards a larger muscle because the muscles, they feel like, you know, the way they say it is that the muscles burning up the insulin, but I don't know, I don't know, imagine that that. Isn't it just that there's not enough like fatty tissue there to move it around? Or no? Well,

Jennifer Smith, CDE 21:06
you know, muscles are, they've got a basketball nature to them, right? So they've got lots and lots of vessels that contribute to keeping the muscles doing what they're supposed to be doing and supplying nutrients and everything into the tissue, right? Whereas fat is just I mean, you've probably seen pictures of like fat blobs, right? Fat balls, right? Imagine Yes, imagine a styrofoam ball, that's a good idea. So when you have insulin infusing pretty close to a muscle, let's say and this is kind of general, you would expect potentially, that you are going to get if you haven't gotten occlusion from nicking a vessel and getting kind of a clot at the end of the canula. And then the muscle because of the nature of vessels, you may actually get faster absorption in an area. Like I've in particular, noticed if I've ever had a site that has bled after I've taken the site out. But it wasn't really, like it wasn't painful. There was no reason to change it prior, but it just was one of those like, gushers that you like, pull out. And then I look back at the couple last days, and I'll be like, yeah, my blood sugar look pretty perfect. Like, it was almost like, I didn't have diabetes, like it was just all working like so beautifully that I felt like, this is just it. I'm just at like this beautiful like point, right? And then I see Oh, well, there's the reason right next to my bud spy,

Scott Benner 22:44
you think he said that it's almost like you're in a very tiny way mainlining the insulin a little bit.

Jennifer Smith, CDE 22:51
And that's what I guess yeah. And it's actually just closer to the absorption line. You know, because when we put a pump site or even inject insulin, you're supposed to be sub sub cute, right? underlying tissue, which is mostly your like, it's like your thermal layer of protection for your body, right, that's where we're supposed to be absorbing insulin through and thus the timeline and the absorption for the trend in rapid insulin, regular insulin, long term insulin. It's all based on how it's supposed to get absorbed in us through that timeframe. Okay, through that tissue.

Scott Benner 23:27
And so I think it's important here to mention that when you buy a pump, any pump, it's going to give you some instructions and tell you here the places you can where your pump all that means is that those are the places that the company who made the pump had the time and money test to test so that they could prove to the FDA that these places worked it and I assure that on the pod probably isn't thrilled if I'm saying this but I you can put your pump somewhere else. Yes, yes, you could try other places I've seen from Chris Freeman where it on his chest, you know when he's in the middle of you know, in the Olympics and that I mean, I've said it before the guys like I don't know what his real body fat is, but he doesn't appear to have any. And you know, and it's on us, it's on his pack. I've seen ladies wear them in their on their breast I've seen people wear them on their hips, their thighs, their calves. I watched somebody do it on their forearm once is like a test, you know, there's no place. I don't think there's any place where it isn't reasonable for you to try based on what I've seen from the community and from people in general. But you are going to find places that work better but then I think that leads us into talking about you can't have too much of our favorite place because you'll ruin it.

Jennifer Smith, CDE 24:44
You have to rotate Yes, very important to rotate

Scott Benner 24:48
have to have to look at your sights and see for Arden they get a little like if she's using them too much I can start seeing them a little vascular maybe like a little red on top like that's the first like sign for And then you can start rubbing your, your you can rub your hand over top of it, if it gets bad, you can feel like it'll get lumpy or hard. Yes, right, that kind of a thing. So yeah, you have to have a place to go. And it is going to change them. Like Jenny said it could possibly change how much insulating Arden just went off the side of her thigh to the top of her thigh. And I had to increase everything by about 20% for that just from the social side of the top of her thigh. So and I think too, for little kids. As long as we're talking about sites for a second, here's probably a good place to talk about when you start doing things with little kids or you know, sometimes adults. They build rules in their head. So that's where my pump goes. It can't go there because it goes there. I always wear it here kind of becomes a psychological thing at some points too. You know, and then you'll see kids will fight against it. Like I can't put it on my arm. It goes on my leg. Yeah, right I Arden 17. And I think she has it. I think she believes her her CGM goes on her hips. Because that's because that's where she likes it where she likes it and it works fine and everything. And if I ever say to her, Hey, why don't you try putting your pot on the back of your arm. It's a flat No. And it's only because in my opinion, she remembers it being there in a softball game one day and we didn't think about it and she threw and then the pod like yanked on her arm as she was as she came across, she had a bad memory of it and now even years later that she's not throwing a softball anymore years later she's has an aversion to putting it on arm you know so sure if there's like

Jennifer Smith, CDE 26:41
an associated kind of experience there

Scott Benner 26:45
Yeah, and then it comes out as this is where it goes and I will fight to the death to keep it here and then you run into a problem where you don't have ways to to rotate sites yes and then you're going to run into a problem and the way I've always put it the Arden is look you keep putting it there and one day you're not going to be able to use that spot at all. And that's that's the thing that helps her move around now I think the other good thing to talk about about that is you know I really have experienced with the Omni pod but sometimes it's just as simple as turning it 180 degrees like you really like it on your abdomen great, have it point towards your belly button this time and have a point towards your side the next time Yes, you know, those are still

Jennifer Smith, CDE 27:23
when I do the same thing you know, especially for backs of the arms which for many little kids because especially for tiny little kids who really don't have a lot of tissue or are very very averse to having it on their abdomen for some reason you know, then that back of the arm like you said it's essentially just turning the pod with that viewing window facing up versus the next time turning it with the viewing window facing down to technically then even have two sights on the back of each little arm that you could potentially use which makes for places between two arms at assumably three days per site. It's a fair amount of these before you get back to site number one on the first or

Scott Benner 28:10
do you think specifically on on the pod? You use it vertically? On limbs right?

Jennifer Smith, CDE 28:17
Correct yeah perpendicular up and down with the viewing window either facing the sky or facing the floor on limbs exactly and then on like your torso region or your upper but you would use it in sort of a horizontal fashion

Scott Benner 28:33
is that because of just the nature of the shape of the pod?

Jennifer Smith, CDE 28:37
Yeah that's from what I know it's nice it's based on the wear comfort wear of the pod itself Yes

Scott Benner 28:45
Do you know a second ago because I didn't want to look stupid I just checked it vertical up and down. Like I googled it right before I said it and then it made me feel so much better because the rest of the world doesn't know either. It's it's a very popularly Google thing is horizontal left and right is vertical up and down. What is vertical? What does a vertical line look?

Jennifer Smith, CDE 29:08
Pretty funny is that paid closer

Scott Benner 29:09
attention in school. Anything about this that we didn't cover?

Jennifer Smith, CDE 29:14
Um, I don't think so. I think in terms of site you covered you know, all the places that are approved versus the ones that people are trying that necessarily approved. So

Scott Benner 29:28
yes, but it's a variable because you are going to get it in your head that these are my settings, and then you're going to move the site somewhere else. And then you start I love it, people immediately go this pump doesn't work. That's always my favorite reaction to everything.

Jennifer Smith, CDE 29:41
Right? And I've got a number I mean as a secondary to that site to site going to number of people, myself included before using, you know the system that I actually use. I actually just had separate basil profiles that I would use from one site to the next more specifically, all Body sights on me work pretty much the same except for my upper but my upper but just seem to need more insulin whenever I used it. So I had a profile that was specific to that. So do you

Scott Benner 30:12
think that and then I'll let you go. But do you think that the advent of g7 Dexcom. Like when it changes form factor? I keep thinking people are going to start trying like a lot of different places because it's going to be easier to put in different places all

Jennifer Smith, CDE 30:27
this probably, I would expect. Yes. I mean, as it is, a lot of people are wearing their CGM is on places that I would honestly like they're, I've seen it on their forearms. I've seen it like, places I would never think of popping it in. But I think getting accurate results. I

Scott Benner 30:46
guess I have to admit, there are times I see those pictures, and this is exactly what I think and I'm just gonna have to bleep this out. I think, man, skateboard, huh? I wonder if we can make it work here. I'm gonna

Jennifer Smith, CDE 30:59
I know I don't even have like, I don't it's all muscle there. I don't know where it would sit under my skin. I would hit something and it would be immediate pain or blood. I

Scott Benner 31:10
I just think of those people as they're they're explorers. They just like I wonder what will happen if I walk across Antarctica? You know?

Unknown Speaker 31:18
Right, exactly. Go find out exactly. I'm

Scott Benner 31:20
not doing it but whatever. Okay, thank you very much. First, I'm gonna thank the Contour Next One blood glucose meter remind you to go to Contour Next one.com forward slash juicebox. There are also links in the show notes of your podcast player, and links at Juicebox. Podcast calm. Thank you very much for visiting with the sponsors. I appreciate it. Thanks, also to Jenny for being here. Thank you so much, Jenny. We love talking to you. At least I do. I think I'm speaking for everyone else. But in fairness, some people might hate your guts. I have no idea. Is it possible that anyone doesn't like Jenny? I don't think so. Thank you so much for listening. There are way more variables, go check them out at Juicebox Podcast comm or right there in your podcast player. Really appreciate your listening and supporting the Juicebox Podcast. Tell a friend. That is my least favorite part of making the podcast asking you to like tell somebody else. Don't forget to subscribe and your app like it's, I feel like oh, I feel like an idiot having to say that. It's like I see a YouTube video, you know, and they're like, hit the bell do the thing. And I'm like, Oh, this is so sad. And then I come here and I have to do it here and it just it's hard to get people to listen to things and and subscribe and you know, it takes so much for them to learn that the contents there and that it really might be valuable for them. So then I end up saying like, just please tell someone who else you know and just, I don't it makes me feel weird. I don't like it, but I do it because it is important. So thank you so much for listening for supporting the show. If you know somebody else who you think might enjoy the show, also please share it with them, show them how to start listening. podcasts are not intuitive for everyone. Subscribe in your apps people. I just did it. I was like hit the bell thing. You know what I haven't mentioned this in a little bit. The Facebook page is really great. No joking. Juicebox Podcast Type One Diabetes on Facebook. It's a private group with I think it's got like 16,000 people and now everyone's talking about diabetes to really on Facebook like experience. So that is to say it's a good experience with a lot of great people. Check it out.