#657 Eavesdrop On Our Call

Amanda wants to talk about her sons type 1 diabetes.

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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 657 of the Juicebox Podcast.

Back in the day, I used to talk to a lot of people on the phone about type one diabetes. I still do it every once in a while now, but not too much anymore. Recently, Amanda reached out to me, and she was looking for help. And I said, Well, I can talk to you, but I don't know when I can do it. But if you're willing to let me record it, then I can do it sooner. She said, okay, and then that's what we did. So Amanda is the mother of a child with type one diabetes. And today she and I are going to talk about her questions. It's going to be like listening in on a phone call between Amanda and myself. Please remember that while you're listening to the Juicebox Podcast, that nothing you hear, wow, I just forgot the thing. Never happened before. Wow, I'm stunned. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Or becoming bold with insulin. That's never happened before. It's very interesting.

Hey, welcome a new sponsor, won't you pretend I'm playing a bunch of like fancy music here like a carnation is happening or what was that music when they presented Simba for the first time? You don't mean play that in your head? That whole thing with it, and he said it about uniform. Alright, you get that going in your head right now. Ready? You gotta go. Alright, this episode of The Juicebox Podcast is sponsored by us med. US med provides 90 days worth of the supplies that you need. And they also have fast and free shipping. If you want better service and better care. Try us med you can get your free benefits check at us med.com forward slash juicebox. Or use this dedicated phone number just for Juicebox Podcast listeners. 808-721-1514. It's pretty cool, right? A new sponsor. This episode is also sponsored by someone else you want to hear about it. Why not? This episode of The Juicebox Podcast is sponsored by touched by type one, Learn more at touched by type one.org Or follow them on Facebook and Instagram.

Amanda 2:46
I am Amanda. I'm a mom to two boys. My oldest is let's see. He's 13. And will he'll be 14 in January and my youngest is 11. My youngest is the type one. And he was just diagnosed in May of this year. Cinco de Mayo actually.

Scott Benner 3:04
Oh, celebrate. Yeah, yeah,

Amanda 3:08
exactly. Normally, we would have been. Yeah,

Scott Benner 3:11
right. But instead of a set of a beer and salsa, you're Yeah, in the hospital.

Amanda 3:17
We were getting all educated.

Scott Benner 3:19
Let me I know, we're we're talking today for a really specific reason. But just just for a second. So we get to know you a little bit. Was there any sign of this? Is it in the family? Anything like that?

Amanda 3:30
Yeah, good question. So we do have autoimmunity in the family, but no type one diabetes. And oddly enough, exactly six days after my son was diagnosed, who's the first in the family that I'm aware of? My niece, my brother's daughter was diagnosed. Okay, exactly six days later, and she was diagnosed. I mean, I really because they saw they heard our story and her the symptoms that we saw on our son and they're like, oh, that's odd. Our daughter is this doing the same things. And so they took her in and oddly enough, she also had it.

Scott Benner 4:03
When I hear that you know what it makes me think what? I'm so disappointed in my Spanish I can make a joke if I knew what six days later was called, and then I could say de mio after it. And I was like I said, I'm like quatro, cinco, say, you know, trying to get and I'm like, I got like three more passed, and I was like, I'm never gonna make it six. And go damn it. Yeah, that's interesting. Now there's two of them. And now the whole family is on the lookout to I bet

Amanda 4:32
you got it. Yep. Cuz there's a lot more cousins to go.

Scott Benner 4:37
Yeah, no, nobody's gonna ever get to pee three times and a half a day. You're in your family ever again.

Amanda 4:42
Seriously without somebody looking with a funny eye? Yeah.

Scott Benner 4:46
Well, how's it so means not that long ago. Now for four months, maybe? A little more. How? And and we're talking today because you reached out privately for help right now. I was kind of so overwhelmed that I said, Can we just do it on the podcast? Is that? Am I remembering that correctly? Yeah. Okay. So this is going to be either interesting or upsetting to people, we'll find out, but it's going to help me. The reason I say that is because when I'm having a conversation on the podcast for you all to listen to, it's a little more. I'm more worried about the flow of it. I'm worried that you're having, you know, your part of the conversation that we're getting out what you think. But this conversation is going to be a lot of me asking questions, and then you answering the questions. And me saying stuff. So it's gonna be less conversational, but you're up for that you already know. I just want people listening to know that, you know, this is, this is basically my idea with this is when I speak to somebody privately on the phone, we're gonna record it today. So and you were mad, or you were very nice to to agree to that. So. All right, all right. Anytime, please, anytime. situation, you're gonna have to have another kid with diabetes. So we can do that again. So you don't really mean. Right? Let me get my note here so I can write some things down. Kelly bought me this little whiteboard that goes in front of me while I'm on the podcast and very helpful. Okay. How old? Tell me it's 1111 How long? Five months? Five months? What? Insulin cumilla Log? Pump, no pump.

Amanda 6:35
She has the tandem are using control

Scott Benner 6:39
IQ. Yes. Dexcom G six. Yes. How much does he weigh?

Amanda 6:50
Roughly 80 pounds.

Scott Benner 6:53
What's his Basal rate?

Amanda 6:56
You're gonna ask me, I'm trying to pull it up. Because it changes I think weekly at this point. That's

Scott Benner 7:01
fine. Arden sick right now. I have her insulin doubled. Everything's doubled. I'm barely able to keep her blood sugar under 180.

Amanda 7:09
Yeah, so that happened to me. Last week, I want to say he had a head cold and I was like, getting insulin like a mad person and he literally doubled his

Scott Benner 7:21
Basal rate. Yeah, but what is it normal?

Amanda 7:24
So normally he is getting roughly around six units a day. So he's like, I'm doing five units an hour it fluctuates a little bit between night and day time six divided

Scott Benner 7:39
by 24.25 Do you think he's honeymooning? Absolutely. Would you describe your diet as a generic American diet? Are you doing something specific?

Amanda 7:56
Oh, no. He's generic American. His let me tell you his favorite meals are macaroni and cheese. If you know anything about the Midwest, you know, Skyline chili, which most people don't like if you don't if you're not born here, but it's pasta with chili on top of it. Yeah. And cheese and crackers also and then hot dogs. And oh, almond butter graham crackers. That's like his. Those are his favorites. So really fun to control.

Scott Benner 8:27
Yeah, graham crackers are tough. Yeah, yep, they are. Okay. How Midwest are you? Like, have you ever deep fried an Oreo?

Amanda 8:37
So they do do that here. I've never had them good for

Scott Benner 8:39
you. Quick side aside, my brother moved to Wisconsin years ago. And he came home with a woman who he eventually ended up marrying one day and she brought like, you know, she tried to bring treats like something colloquial to the time of year. And she brings these kind of like gallon zipper bags full of I don't remember what she called them. But you know, when you go in the grocery store near the potato chip aisle, and there's these like, cheese balls. Like they're like these, but they're popcorn. So they're air pop balls. I don't even they're not really popcorn, you know? I mean? And then they were soaked in sugar. Oh my gosh. And she's like, I make these with my mom at Christmas. I was like, This is not okay. Like you took a you took a thing that's not food. Like it's a pretend food. Right? It's not really even popcorn. And you soaked it in Carmel or something or sugar. And and now you're eating it by the handful. And it was very reminiscent of the holiday for her. Oh, yeah. And like, right. It was like a thing she did when she was a kid. Mm hmm. It was like I was like, I don't understand what this is. It's like It's like low rent. Carmel pop corner. I couldn't supposed to be exactly Like, how hard is it to procure actual popcorn and put Carmel on it? Like that can't be it no difficulty. It was it was a step away from taking a Cheeto and and soaking it in shucker

Amanda 10:11
oh my gosh, yeah, we do a lot of things like that here where I'm from lots of things that are deep fried. And I mean, yeah,

Scott Benner 10:18
yeah. And that this is not an uncommon conversation when I end up on the phone with people who are from Minnesota, Wisconsin, you know, the top part of Illinois like that, like right there. Like we're around those lakes for some reason, like you guys can get food, right. There's no trouble with that. Is there? No. Like the trucks go to where you are? Right? They do. Yeah. Anyway, well, listen, I think we should stop talking about your son's health right now open a case of beer. And talk about the Packers until we just start punching each other would that be okay, that's a great idea. Yeah. All right. What's the problem?

Amanda 10:59
Oh, gosh, that's a loaded question. So it changes constantly, I feel like I feel like I am throwing darts and seeing what sticks most of the time. So I, I feel I've listened to a lot of the podcasts, I've read all the books, I'm the kind of person where when something goes wrong, or you know, however you want to say it, if something goes wrong, I put my head down, and I dig in, and I try to fix it. And I keep learning and trying to, you know, find different ways to go about fixing it until I have the problem fix. Well, this problem you can't fix, right? You can only manage. So I'm doing the best that I can to manage it as quickly as possible. Like I don't want to wait five years to learn all the things that I need to learn. I want to learn it right now and figure it out, which I know isn't entirely possible. But I'm doing the best that I can to kind of speed up time a little bit. Okay,

Scott Benner 11:53
that's a good answer. No.

Amanda 11:55
Yeah. So I think my issue mostly is with trying to figure out and like I said, I feel like it kind of changes day to day with what the issue is, but it's trying to figure out for me, we have a lot of times when right now he's having a lot more lows, and I would like him to have

Scott Benner 12:12
what do you what's a low? Give me a number? Yeah, so

Amanda 12:15
he'll go. Usually he doesn't go below 65. Like he'll he'll start he'll dip down somewhere between, you know, 60 and 70. And we usually catch it before it goes below that. But I would say, I don't know, two to three times a week he'll get down into the 50s. Occasionally a 40. He's a super active kid. That's the other thing. So he does competitive soccer. He does motocross. He does wakeboarding. I mean if it goes fast, and you can die from it,

Scott Benner 12:43
he does it. Gotcha. That's right. That's helpful for your, for your soul. Yeah,

Amanda 12:49
exactly. So. So he's really hard to keep up with because he's just constantly in motion. And so part of it is that I think in my want my desire to keep him from having peaks, particularly after food. So I have a lot of times where I'll do about Pre-Bolus him, and I'll get that I'll watch his CGM, and he'll start to dip. I don't really wait for the arrow necessarily, because I found that if I wait for the arrow to go diagonal, then it's too I've waited too long. And he's gonna go low for sure. Because usually when we're Pre-Bolus, and he usually is in the know, under 100. I mean, usually he's 80 to 90, I would say most of the time. So I Pre-Bolus. I wait for the numbers to go down and then put the food in. And then sometimes he'll dip down into like the 60s, which I know my Pre-Bolus time is off. But then the thing that throws me, it's hillclimb to 150, which I know in theory isn't very high. But when you're going from 60 to 150, it feels like that's not enough insulin somewhere, right? Because there's a huge swing, right? And then Hills come back down and to 80 or 90, usually within three hours if you know if he's gone up to the 150s. And sometimes he'll even go from, you know, the 70s up to 180 and then come back down. So I wonder if it's an insulin thing now that I'm seeing this out loud.

Scott Benner 14:02
Okay, well, hold on. So I got what you're saying. Let me say this, because I'm, I guess I'm fun being honest. It's not going to be completely like a phone call because I am cognizant that other people are going to listen. Right? So there are two types of people who have the nerve to reach out to me. Yeah, and the nerve because obviously this is not something I do for a living like you're not paying me and you know, so it feels like an intrusion. So there are two types of people I've got a broken down I know for sure. It is. Either someone who is in such a bad situation, that they're willing to talk to a stranger on the phone because they think that they're about to die or kill somebody. Okay? Like No kidding, right? It's that bad of a situation. Or, or it's not like me who's neurotic? It's a type a mom who gets on the phone and is like, Hey, I got a real shit show. Over here, Mike. See is 6.1 and sometimes his blood sugar 65. And we got to fix this. And, and when they start talking, I start thinking, but you're doing a really good job. And then, then we're gonna find out as we talked about it, do you know you're doing a good job? Or do you not know?

Amanda 15:20
So I think that's part of the problem. I think I know, for the most part that I'm doing a good job, but I feel like, you know, when I look on social media and things like that there are people who don't go above 120 with their posts, meal spikes, and then they just feel like it's possible for it to be better

Scott Benner 15:38
it is. And you'll find it I imagine. I mean, if you don't mind it, who's going to write and? And I don't mean because you love him and you're his mom. I mean, cuz you're mentally unstable. And yeah. But in a lovely way, so it's not a judgment. It's like you're not out like trying to kill Batman. You know what I mean? Like, there's no yeah, you're fine. No, yeah.

Amanda 16:01
Yeah. I'm all in. I'm mildly competitive, which I think is part of

Scott Benner 16:07
how clean is your toilet? Tell me right now.

Amanda 16:09
It's pretty clean.

Scott Benner 16:15
You ever seen? I can't believe I'm saying this on the podcast. But if you ever seen a pubic hair around the toilet rim and actually gotten angry at your husband then you're not doing terrible. You're doing great.

Amanda 16:27
No, but I'm not going to answer why I haven't seen it.

Scott Benner 16:30
God is your husband shaved? I don't want to talk about this right now. And you just say yes. How does he stay warm? In the Midwest? Listen,

Amanda 16:36
I work in health care. Like no, I nothing bothers me.

Scott Benner 16:39
Can you believe you just said that? It's fine. It's fine. I mean, in the back of my head, there was this little voice that just said, this is why this podcast is so good. Because we're all so comfortable together that you and I complete strangers. We are 15 minutes into our conversation.

Amanda 16:58
Yeah. Talking about my husband. tearless. Yeah.

Scott Benner 17:02
Wow. Do you think what? Oh, my god, does he do it? Because it makes it look bigger? Would it? Why is he doing

Amanda 17:07
it? I don't know. You know, I don't know.

Scott Benner 17:09
I've never really asked him that. You got it. It's not for you.

Amanda 17:13
I have no idea. I don't really I kind of do care. Actually. I prefer it.

Scott Benner 17:22
I don't even care if your kids healthy anymore. Let's keep talking. I'm just kidding. Alright, so my first thought when you tell me that you're doing a Pre-Bolus that's creating a 60. Then you're finding 150. And it's taking two hours to go back to level that my first thought is not terrible. And it's getting back to level without going low. It's getting back to level without another Bolus.

Amanda 17:49
Most I mean, sometimes that happens, sometimes it doesn't. Sometimes it has to have another bullet. Sometimes he does go low, but I catch it before it gets low. You know what I mean?

Scott Benner 17:57
So then I kind of drift back to the things he's eating then. And I'm not telling you to change them. I'm telling you that right. You know, if you're if you're going to have hotdog, for example, Have you have you put some effort in defining a bun that doesn't impact as hard? Like that's, I know, a stupid thing to say. But their breads hit differently. And if you try a couple of different like I would I would say to you, are you using bread that has no high fructose corn syrup in it?

Amanda 18:30
I honestly haven't looked. I don't know. I use wheat. Whole wheat bread.

Scott Benner 18:34
Yeah. Oh, there's another one. I'd stopped doing that two. Oh, come on whole wheat bread people think of is healthier. Yeah, but I think it hits harder than white bread. If the white bread doesn't have high fructose corn syrup in it, and it's made in a kind of certain way. I know. That's weird. And I'm not saying you can't find a wheat bread that isn't. doesn't do that. Right. But you got to look a little bit. Yep. All right. So so think about that. If you could take the impact of 30 points out of the role, then then you've got that one. Now you're 120 Maybe and you come back and maybe maybe you'll find out even then at that meal doesn't need quite as much insulin. Okay, it might not even need quite as long of a Pre-Bolus. Because, you know, I I know I've said it enough times, but it definitely fits right here. We do not think about the food enough. Right? Like they and it's I really do believe it's because when your doctor talks about it, they tell you like Be careful the glycemic index and the glycemic load of your foods here. Like I didn't listen in science, Betty. You know, why you Yes, glycaemic to me, but I mean, the quality of the foods is a big deal. And it's going to be harder, like processed food. Food that has sugar in it for no real reason other than it tastes good. Like that kind of stuff is going to is going to get in your way. Yes, but taking that out of it for a second and just thinking about the situation you're putting in insulin early enough to see a pretty significant decline as a Pre-Bolus. Right. And then how long after that is the 150 happen? After every addition? I

Amanda 20:20
would say from 45 minutes to an hour.

Scott Benner 20:25
It's always 45 minutes. Okay.

Amanda 20:28
I know. Yeah, it kind of it just starts to kind of slowly climb. It's not like a straight up rapid up, but it's a slow climb up to the 150. Is and then it's, it looks like a mountain. Do you know what I mean?

Scott Benner 20:40
Yeah. So how focused Are you on this? Like, if I said to you, you could Pre-Bolus What do we say is Basal was point two, five, you can Pre-Bolus the meal, and then take out. I don't know take out a quarter of a unit from the Bolus. And at the same time, you Pre-Bolus double his basil for an hour, that maybe you could shift some of the insulin around to try to impact your situation. Now this could go wrong. I might be wrong about this. Sure. Right. Say that one more time for me. Well, what if what if you like, let's just do round numbers and say that the hot dog launch that we're talking about here is for is four units. Okay? Am I way off on that? Or Is that about right now? Okay. And then make it 3.75 And then do a Temp Basal increase for an hour except you're on control IQ.

Amanda 21:34
And then I know so what I've been doing because of the control IQ is I will add in some more carbs and I'll extend the Bolus

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add in more carbs and extend the Bolus so that

Amanda 24:36
he's getting more insulin.

Scott Benner 24:38
It's your line nice,

Amanda 24:39
extend the Bolus out

Scott Benner 24:41
lying about the carbs extending the boss explain to me the extended Bolus no control IQ you can tell it.

Amanda 24:47
So with control IQ because of the way that control IQ works, it's gonna change the Basal for me if it needs to. So rather than and I could if I wanted to I can turn off control IQ and I could mess with the basil on my own like I can, I can do a Temp Basal if I wanted to. But when he's at school, I don't like to turn it off. So I generally don't because I want it to catch things, especially if it's going high or low when he's at school. So to kind of get around that I will. So for a lot of his meals, if they have high fat in them, so typically over 20 grams of fat, I will take half of those fat grams and I'll add them into the carb Bolus. And then I extend the Bolus to cover the fat rise that's going to happen later. More than likely or like for example with the mac and cheese because I know that that's a slower digesting food. I will add in a few more carbs and what it really is, and I'll extend out the Bolus so you can put in you know, 80% up front 20% over two hours.

Scott Benner 25:51
80% up front 20% over two hours, so you can hold on a second. My daughter's texted me about her and son Kimmy. Yeah, but I'm telling her about an override for her loop. Trying to decide what I just she's like, You didn't finish the thought override in the end, forever 150%.

I didn't say forever. I didn't tell her for how long to do it. Arden has what she's calling college flu. Even though she's even though she's in so she tells me last night like very grown up in the kitchen. She's like, I have the college flu. And I was like, Oh, what is that? And she said I have a cough we all have it because we got back together and we haven't been together for so long. The whole schools coughing unless Oh, great. She goes I don't shoot. I don't have COVID I would no of course not. You'd be the best person to check with on that not a physician or a test or something like that. And then my son told me the same thing. They went back to college he said everybody's coughing he's like it's just not it's not going away. How's it go? Great. Okay, excellent. Yay. Perfect. But her insulin needs on whatever this is are unlike anything that I've seen in a while because really Arden doesn't get high with in with illness she gets lower. For you. Usually an illness for Arden's like a good is good news. We get the Turner basil down, and she just rolls through it. But she had she's been having like, Oh, my God, I've had her basil as high as like, two 2.4 an hour at time at times during this trying to keep it together. Yeah, the Bolus don't seem to change much for the food, like her insulin to carb ratio is still the same. Yeah, so fine.

Amanda 27:50
So when she has things like that happen, like if she starts to kind of creep up and gets higher, how long do you watch it before you start it? Like especially if you're doubling her Basal? How long? Are you watching it before you keep going up?

Scott Benner 28:03
Amanda? That's classic newbie question. Very good. This is one of the favorites. Scott, please tell me how long I should wait before I do this.

Amanda 28:10
I mean, I know that it's different for everybody. But if I just have a generalization.

Scott Benner 28:16
I love watching your brain torture, man. So honest answer is it's one of those things you figure out over time not to hate that answer. Okay. It's one of those things that you'll just learn to see. And then it just, it's there then, and you just go right, so I noticed her cough two nights ago, when I noticed her cough, it made me go look at her, I pulled up her 24 hour graph. And then I saw I noticed that we had you know, like one of those meal things where you think, Oh, I missed the meal. And it just gets high and it won't come down like in UFC that we were fighting with it. I got it back. But then as soon as I had it back down, it felt like it wanted to go up again. When that happened, we changed our sight because it was like two and a half days into the pump. I thought that might just be a bad sight. And then we got it level with some boluses and then that started drifting up again. And then as soon as that happened, I increased her Basal. Okay, that makes sense. Yeah, that's how I did it now. Okay, you know, 10 years ago, my answer would have been it took me six days. I thought she was right. Or blood sugar was 250 most of the time and because why? Right? Because the fear is that you're gonna like Jack in all this extra insulin and then look up three hours from now and the kids blood sugar is gonna be 40 and falling and it's gonna need 70 carbs to stop it like That's right, right? Yeah. I don't know. I just know what it looks like now. Okay, you know, and I and I did some like, you know, some testing with changing the site and then you got to give yourself some time because a new site doesn't work like magic right away. Last night, we had it. I thought we had it. And I, you know, I had her pretty, you know, everything was turned off pretty much. And a friend of hers came over, I'm guessing so they could spread around the college flew or whatever it is. Right and. And she's like, can you make us popcorn? And I was like, oh, okay, sure. So I just, I finished what I was doing. I made popcorn. And then I looked at her blood sugar because popcorns not hard on her. And I was gonna just text her and say, Hey, Bolus, and her blood sugar was like, 210 Straight up, and it just, it's like, 20 minutes before it just started jumping up. And I was like, I texted her. I said, Hey, what did you just eat? She goes, I haven't eaten anything in hours. I was like, okay, so I knew that was this. So I changed the strength of her insulin. I mean, she's looping. So I mean, for people listening, like I basically did a Basal increase of like, 100%, like, you know, instead of 1.1, an hour is 2.2 an hour. I Bolus the number. And I shut off the algorithm. So it couldn't take away her Basal. Okay, because I knew I was in a very specific situation, right? We crushed it again. And as soon as they got back down, and that override of basil ended, it tried to try to go right back up again. So overnight, I think she had basically like one and a half times her normal Basal rate. And still she woke up at like one ad this morning. So the I've been crushing the one ad for the last hour and a half. Interesting. Yeah. And now I have it. I've I think so let me look. Why 135 Diagonal down. Nice. Yeah. So that's why I just changed her override. Around I had a 200%. Now I moved it back to like, 150%. Okay, again, think of that as like Basal increase 150%. Also, it impacts corrections to but when it asked for. So you turn the loop up to 100%. And now if it if it in a normal situation in these, in whatever situation you're in, it wants to units as a correction, it'll tell you once four units because it wants twice as much as so when it told us like about an hour ago. She's like, hey, this thing wants me to Bolus like 4.8 units as like just due to Oh, yeah. Okay, because we had done a little earlier, and four units would have been way too much. And by the way, yeah, even if it wouldn't have been. She's at school, I'm not going to give her five units of insulin to correct at 180 When she's not with us. Like the next thing I said to her was, do you have juice with you? And she's like, Yes, I was like, alright, still do too. Let's watch it for 45 minutes, I figured I'd be talking to you. I could keep my eye on it. This was about the time. If she wasn't coming down right now I would have put the other two units in. So it's an interesting look into that the algorithm, whether it's Looper control IQ, or I imagine on the pod five and the future, whatever it is that you know, Medtronic is going to do.

It only knows what it knows. It can't understand the other impacts, for instance, that you buy wheat bread with high fructose corn syrup. If you do you know, or that Arden's having an illness that's impacting her Basal needs really drastically, right? It doesn't know that. It just sees it sees the settings you put in, and what the blood sugar is, and whatever, however, it's interpreting the trend. Right, right. So it's a stupid smart system. Angry? Yeah. Yeah, with this meal thing that's happening to you. Have you ever shut off the control like you and tried the same meal like manually?

Amanda 33:59
No, I have shut off the control IQ a couple of times, not necessarily for the same meal, just to kind of play around with it and see what happens when I do that and see if I can manage it better. I think the issue with the tandem in particular is that it's connected to him. And so anytime I need to make a change to his insulin needs, whether you know if I have to Bolus or change his basil or whatever, I need to go to him and take the pump from him to put in the setting changes or you know, the correction or whatever it is. And he gets annoyed by that. And so I think that I kind of back off more than I would like to because I don't want to drive him crazy.

Scott Benner 34:39
Have you ever tried my tactic? When they look annoyed? Just look at him and go Oh, shut up.

Amanda 34:46
He would probably so he and I are that we're cut from the same cloth for sure. Like we are exactly the same person. And so we butt heads a lot and so

Scott Benner 34:55
Oh fun.

Unknown Speaker 34:56
I don't think that would end well.

Scott Benner 34:57
You know when that's gonna get better in like a year. halfway he has testosterone.

Amanda 35:02
Yeah, luckily, I work out a lot. So I think I can take him,

Scott Benner 35:05
but you might have to work out to get your frustration out. Yeah. So here's my next question. Away from an active Bolus away from food. So food hasn't been in a system for three, four hours. Where does Where does his blood sugar sit stable or does it not?

Amanda 35:24
No, it totally has. Basil is really good. I've got that nailed down. So like last night, he was one of the five.

Scott Benner 35:32
One of the five overnight, huh? Okay. Does he ever sit lower overnight? Yes,

Amanda 35:38
he does. But the dumb control IQ kind of brings him up sometimes. So if it goes below, one 12.5 it'll shut off and then it kind of bumps it back up. So it's like a love hate with the control IQ. I haven't totally figured out how to work with it. I think I'm still working against it for

Scott Benner 35:55
sure. Because it's getting it's targeting like that. 112 and a half.

Amanda 35:58
Yeah, yeah. Yeah. So I would prefer I mean, I do get him sometimes to right around 80 or 90, and that's where I would prefer him to be but I'm still trying to, like I said, figure out how to work with control like you instead of against it. Totally.

Scott Benner 36:13
I'm just wondering, like, because Because point two. I mean, it's obviously honeymooning. Yes. Because point two five for 80 pounds is low. Right. Right. So

Amanda 36:26
yeah, he's getting like 70% of his insulin is Bolus in like 25% is Basil. Something like that. Okay.

Scott Benner 36:35
Yeah, that's, I mean, I know there's some people who like use that percentage like, like gospel, and some people don't care about it as much, but that's pretty wack. Like, as far as right. Yeah. Do you see any signs of attending? Have you ever had a day where his pancreas wasn't helping? No, not yet.

Amanda 36:52
Which is kind of annoying. And it's kind of all over the place to like, it'll help out more, some weeks and others and it's hit it like it. It's driving me crazy, because I swear, I really honestly feel like I'm changing his basil almost every week. Definitely. It changes between school and the weekend always buy quite a lot. I feel like I mean, he can go down to four units of basil on the weekend, compared to the six that he's been getting recently. Anyway, when he's at school more sometimes he goes up to eight units when he's in school. It just it's like all over the place. So

Scott Benner 37:22
he's more active on the weekends. For sure. more sedentary during school? For sure. Okay, and you said driving me crazy. But you've misspoke. You should have said crazier. Yes, that's true. That's fine. distinction I make with my wife. Sometimes she's like, this is making me crazy. And we all like crazier. Let's not try to let's not try to take credit for a baseline of zero because it doesn't really well, okay. So you see, you see that when he's more active, and he's less Basal when he's less active, excuse me when he's more activities less Basal when he's like that. But that makes sense. less active, he needs more basil. His Basil is definitely low for his weight. So I completely agree, obviously with that, but does the I wonder how much it's being helped with the meals as well like, because now you're trying to make adjustments. So here's the thing, right? When you wait for people who don't understand when you Bolus with an algorithm, most of them, that's fine. Most of them will take when you're posting for food with an algorithm, the algorithm has you put in all of the insulin that it needs for the for the meal, meaning the impact of the food, but it's also kind of covering the Basal need to. So loop, for instance, you put it in light of Arden has 40 carbs, we've almost 40 carbs, if her blood sugars already at then, prior to this meal, it's been achieving the 80 by keeping her Bazelon. As soon as the food goes in, excuse me, as soon as the Bolus for the food goes in. Oftentimes, the algorithm takes the Basal insulin away, because it's trying to work with just the Basal and control like you does that similarly, is that right? Yes, correct. So my point about us specifically is when it's doing that, it's only taking point two five away. Right? So it's not like in Arden situation where her Basal goes away. I lose a unit of insulin an hour. Right, right. If you're using you're losing point two, five. So the question would be, obviously the next step you tried was adding a little extra carbs lying about the carbs. If it's 20 carbs, you're telling it it's a little more so that he gets that extra insulin that's being taken away by the Basal but that doesn't help either. Right.

Amanda 40:01
No, I mean, sometimes it does. But most of the time, I would say No, it'll he still gets that, you know, what I would say as a spike up even though I know it's not like a crazy spike, but he gets that spike up still and then okay, sometimes even he goes low afterwards, and I have to catch it with food before he actually gets low cuz I can see it coming.

Scott Benner 40:22
So when you when you fake carb, you can get low afterwards.

Amanda 40:27
Say that again? When I say carb, I

Scott Benner 40:29
can let you he can get low afterwards. Sometimes Yeah, yeah. So I bet if you took if you step step back, you would notice that the he's getting low afterwards when he's eating. But I'm just gonna say better because I don't have another word better food, like, right? Less preservatives like etc, etc, whatever. And so that's an that's a situation where you're lying to the algorithm helps you up front hurts you on the back end, because on the back end, it expects her to be carbs there that aren't there. And that's why you get slow.

Amanda 41:00
Do you? You don't think that it's an insulin issue like a human long issue.

Scott Benner 41:07
I think the fake carbon with an algorithm is a good way to be low later. Yeah. Unless you're, you know, he's having macaroni and cheese with, you know, those popcorn or things that I mentioned earlier, that I think you should probably just open the humor log and sprinkle it on his head. So just like a flower just here, buddy, we need extra Yes. But with the regular meal though. Fake carbs with an algorithm with a regular meal is a is a good way to be low later, because it thinks there's more carbs in there than there is it's still pushing at it. And so you're doing it to trick it into giving it more insulin to overcome the the Basal being taken away, and it works in the beginning. And then at the end, there's nothing to prop up the insulin and boom, you go down. Now you could I mean, if you're comfortable with giving a little more carbs later for that, then it's not really a problem. It's a viable solution. But it's not. I mean, I don't know how long you could do that without making you crazy. Or you also don't want to put on weight from extra food that he doesn't want to be eating.

Amanda 42:15
You know, and I Yeah, and I hate that he does as much sugar as he does some days to try to catch lows. Right,

Scott Benner 42:22
right. So okay, so what are some of the options? I see the one out a one thing that I have available to me with loop that you don't is I get to tell the loop how long I think the food's gonna impact for. So when Arden has macaroni and cheese, you can put an impact time have five or six hours, which gives the loop the expectation that the food is going to be in there that time and it will keep kind of pressing out of them. Because yeah, you can't do that with control IQ. You also can't readdress a Bolus was control IQ. Right? You can't like I don't know, say, This meal is 25 carbs at eight o'clock in the morning at 830. And at 830. realize, oh, I should have said 30. You can't go back and change the 25 to 30. You correct? Right? You could put in a new 20 new five, but then that messes up the algorithms understanding of the timing of the food then correct? What happens when you don't? Pre-Bolus as long? Does he just get higher?

Amanda 43:25
Um it's hard to answer. Not usually because I know if I know he's not going to get along Pre-Bolus, then I add more insulin into catch what I think is going to get high.

Scott Benner 43:40
I say Oh, so you don't know what will happen because you're already trying to

Amanda 43:44
preemptively assuming that it's going to and so I'll add in more insulin to try to stop that from happening. If I know that he's not going to get a Pre-Bolus or at least as long as I would like for him

Scott Benner 43:53
to Are there any meals where he doesn't spike and he doesn't get low later.

Amanda 44:00
I mean, yeah, they do happen. But it's he doesn't eat the same thing twice, ever. I mean, he eats. He eats the same, I don't know, five, six foods, but he pairs them with different things every time. So then they impact differently based on what he pairs them with. I feel like so I can't get a real good understanding of one meal to the next because of that.

Scott Benner 44:22
You're the first mother 11 year old to complain that their kid has a variety of food choices.

Amanda 44:27
I know I know. I know.

Scott Benner 44:31
I understand God, I'm sorry.

Amanda 44:33
No, you're fine. I don't remember what I was gonna say it wasn't anything important. Probably

Scott Benner 44:37
not. I'm just kidding. Okay, so is this the time where I tell you that for a honeymooning, 11 year old who's had diabetes for four months. This is going really well. What's this a one seat Hold on? Let me guess is a one 110 Most the time doesn't really spike over 150 months. Maybe 180 Once in a while sees lows infrequently, can get as low as 65. I'm thinking, I'm thinking Hold on, hold on, I want to get a really good guess here wins last time you had to say once a

Amanda 45:17
little more than three months ago, he actually goes, I want to say next week.

Scott Benner 45:21
Oh, you don't really have one right now what is Dexcom? Now what is clarity? X calm says that it's going to be 6.10 That's my guess. Damn, I should have said it. Damn it. Damn, damn, damn Damn. Yes. So what was he when he was diagnosed, they didn't

Amanda 45:36
draw one in the ER, which really annoyed me. So he went back for a follow up two months later, and two months in, he was 8.8. So he had two months of good control plus one month of crazy numbers before diagnosis in that point.

Scott Benner 45:50
So man, to be clear, your son's had diabetes for four months, he's 11 years old, eats a bunch of different foods is incredibly active only gets into the 50s maybe once or twice a week and is a one C 6.1. Yeah, what made your comment again?

Amanda 46:05
Oh, man, I know. See, it's because I feel like I can do better with the hosts meal spikes I worked with. I've worked with a company that you talk about a lot. And I was kind of frustrated because I felt like I have a lot of knowledge coming into this just because of my background, not with type one, but just in general medical knowledge and nutritional knowledge coming coming into this. And so I felt like a lot of the education was very surface level and beginner which I do need to have reminders of those things. But I really wanted to dive in and really learn what I can do with control IQ specifically, and how I can work with it better. And I didn't feel like I got that. And so I really just I know that I can keep those piecemeal spikes from going from like, it's just the the range of the jump, right? So if he goes down with the Pre-Bolus to like 70, and he's jumping all the way to 151 60, then I feel like that's telling me that something's off there. Even though it's not a bad number necessarily to jump, you know, I understand 7080 points. That to me means that there's not enough insulin or something, something's off.

Scott Benner 47:18
I didn't mean for my question to throw you into a minor breakdown. I'm sorry. No. Does your husband ever asked you to calm down? And does that make you mad?

I try so hard not to tell Kelly to calm down. I know that there's no value in it for me or for her. But sometimes I just go.

Amanda 47:47
I know. And my type one is exactly like me. He is like a very, he's a an A Oh gosh, a sticky note. Like he writes reminders to himself. He's a he's a task oriented kid. He he's very much like me. And he's very passionate to a fault. So if there's something that he doesn't like, oh, man, yeah, you're gonna have a hard time convincing him otherwise, I

Scott Benner 48:09
have a wife like you and a son. Like you're still see. It's great to

Amanda 48:14
challenge make a lot of amazing adults someday, but right now I tell you what,

Scott Benner 48:17
they'll make great adults make a bunch of money and be dead when they're in their mid 50s from some crazy heart attack. That's accurate. Yeah. So okay, so we want to be able to Joking aside to help you feel calmer, and and help this go more smoothly.

Amanda 48:33
Or just let me know that this is not I guess that's the other part of it. Like, I don't know what normal is. I don't know what to expect. Because obviously, we're brand new at this. So I don't know, what do most people's graphs look like? Or what is what is what should the expectation be when he's honeymooning? I don't know. I'm just trying to make it the best that I can so that he doesn't have complications.

Scott Benner 48:53
Yeah, I hear you that that all makes sense. Um, I would tell you that if you're if you're eating foods that are difficult to manage, and he's honeymooning, then you don't have I don't, I don't dislike 150 for an hour after, you know, an hour after a meal that comes back down and doesn't get low. Like that feels okay to me, like, Could you put in a tiny bit more insulin? Sure. So instead of fate carving, could you have I don't know how that pump is set up? Like could you have a carb ratio? That's a little Meteor for more carbee foods and carb ratio that's a little lighter for simpler. carbohydrate. Yeah,

Amanda 49:37
yeah, you can put in different different profiles in the pump. I think you can have up to I don't know six or 10 or something,

Scott Benner 49:43
because that's what I'm thinking like, maybe you need to profile that's like, you know, sugar depth popcorn and you need a profile. It's like normal. And that way, you'll be more you won't have to lie about the carbs. You can uh, you can be more aggressive with the meal insulin and maybe that would stop the spike. little bit and keep the low way. Okay, that makes sense. Do you sleep mode overnight?

Amanda 50:06
Yeah, no, I don't.

Scott Benner 50:08
I've tried it over.

Amanda 50:09
I have and I didn't like it because it kept me too high.

Scott Benner 50:13
Oh, it made him higher. Yeah, okay.

Amanda 50:17
But I only tried it for, I don't know, two days or something like that. And then I was like, I don't want he was riding right around 120 I want to say, which again, not bad, but I was doing better on MDI, keeping him lower prior to change because I didn't sleep mood, right when I change to the pump. Yeah. And I was doing better with MDI, keeping him lower. So I knew that I could, and I didn't like him stand the 120. So it could have totally just been it was brand new, the pumping to us, it could have been other settings that were you know, I just wasn't, I don't know, maybe I need to go back to

Scott Benner 50:45
it. What's this? What's this meal ratio? Like? What's his insulin to?

Amanda 50:50
See, he gets insulin to carb. So it's he has 123456 Different insulin, the carbs based on the time of the day and the way that it's set up in his profile. So like for breakfast, he's 20 grams per unit. Lunch is the same at dinnertime. He's 21. And at 9pm, he goes to 19.

Scott Benner 51:15
Is there really any difference between 19 and 21? Probably not. No. I'm not laughing at you. I just I love watching people overthink this stuff. Tell me I know, there are people I've been like, tell me about your Basal rate Cisco. Okay. Well, in the morning, it's more aggressive. Point three from 7am to 9:30am. And then it's point three, five for an hour. And then point two for this bottom. i Oh, God. Just Just make it like point two, five the whole day and like, let's see what happens. You know, you can't get caught in trying to outsmart what you think you've seen in the past. Because especially with a with a honeymoon, most of what you've seen isn't real. Like, is it real? I know. It's not what it's going to be later. But it is what it is right now. So I mean, you're that's fine. I mean, point two 1.9 a 19. And 21. I guess whatever. Right. to freak you out. Arden's insulin to carb ratio is one unit per four and a half carbs. We're on it. So yeah, get ready.

Amanda 52:24
I know. Well, I was actually going to ask you that. What does that look like when they go from well did art in how much of the honeymoon,

Scott Benner 52:31
artist honeymoon came months into her diagnosis. And it lasted for two days and then went away? For two days of art and Denita and so on, like months into her diagnosis? Hmm. So interesting. Yeah. Who knows? So

Amanda 52:50
then what does it look like when they when their pancreas totally isn't helping you at all? Because then it's not helped. Because right now, I think his pancreas probably is helping to prevent some lows.

Scott Benner 52:59
Well, you're not using as much you're not using as much manmade insulin, which is probably limiting the lows. Yeah, like this. I'm like, this is like, this is going to get worse before it gets better at some point. Yeah, yeah. You know what I mean? But you'll Yeah, but I want to go back for a minute. Well, let me answer your question. First. I want to say about Arden, Arden got diabetes in 2006. We were using a meter that looked like it came out of a bubblegum, machine and needles. Yeah. So how long did she have a honeymoon? I don't know. But I know for sure that months into it. There were two days where she didn't need insulin. True. Okay. That's all I know. I don't think you're crazy. I think that yeah, I think you're not a clinical diagnosis. But you're welcome. And I think this, I've spoken to a lot of people, and you have all the tools you need to do this. Yeah. The one thing you're missing is consistency from the pancreas, and time to see things in a bigger way. Mm hmm. So what most people have, who succeed is the desire to do it. You have that? Okay. So you want to do it, you want to do a good job, you want to be involved in it. So that's that the the key here would be not to burn yourself out before you get an opportunity to really get in the game. Mm hmm. For now, I would tell you this is probably you're doing great. I mean, you can keep like tinkering with it and everything but just just know that. I don't know. Like, this is the part of the movie where the boats leaking slowly and you're not in the water yet, but save your energy because we're going to be fighting the shark pretty soon. Okay, like don't panic, don't panic in the boat. Let's save that energy for the fight. Because there's going to be a moment where his his needs are going to increase. And that's where you're going to have to be flexible in a way that I described with Arden's illness because basically Arden illness mimics the end of a honeymoon, we have this great degree we have this Basal need that works we have, everything we know that works is here, and then boom, snap of the fingers. It's wrong. And it's not wrong by a little bit. It's not that our Basal needs to go from, you know, point nine, five to one, it's her her Basal need went from 1.1 to two. And it'll end it's going to stop again, by the way, and I'm going to have to adjust off of that at the same time. So that that's what it's going to be like when the honeymoon like hopefully, look, if you get lucky, it'll be gradual, and you can just adjust as you go and it'll just level. But he could just wake up one day and need more insulin. Right, it'll take you a little while

Amanda 55:43
you have to start all over with figuring out how food impacts and all of that.

Scott Benner 55:48
I think the timing of your meal, insulin will be pretty similar. I think his carb ratio will change a little bit not a ton, but his Basil is Basil is gonna change a lot. Okay, so I mean, this is not I you know, I said this enough on the podcast that I this is not technical. It's not mathematical. It's not out of a book anywhere. But kids who are not who are prepubescent. I kind of think of is like point one per hour per 10 pounds. So it wouldn't be crazy. If you eventually found them at point six an hour point seven, that kind of stuff. Okay, you know. And that's where that's the biggest hurdle to me is that people adjust so slowly. So your point two, five, so when his Basal needs go up, I guarantee you, you're gonna make him point three. Yeah, and you're gonna end you're gonna feel like, you're about to kill him, you're gonna be like, 100 to go 2.3 then nothing's gonna change.

Amanda 56:47
When he was sick with that upper respiratory thing for I mean, it was a little more than a week long that I had to change his he went up to point six at night. Yeah,

Scott Benner 56:55
that makes sense to me. So, so just when that time comes, just, you know, it's a good time to find your balls, you know? Yeah, and, and, or otherwise, you're gonna spend days and days and days going from point two, five 2.3 to point three, five, and then you know, everything else is going to be bonkers. Nothing's gonna make sense. And we're not gonna sleep and five days into it, you're going to be running your head into a wall. Right? And then calling and calling a perfect stranger on the phone for help. Gosh, I know, too bad.

Amanda 57:25
So tell me this with Arden? How often are you like texting with her at school to make little micro changes to her insulin, or I mean, I know probably now it's not quite as much as it was when you were figuring all of this stuff out. But that's the other sort of hesitation that I have is that I don't want to interrupt him. His thought process when he's in school a million times to get him to bump a number down or whatever the case may be. So I'll let them ride a little bit higher when he's at school, but I don't know. Like, what do you typically do? or what have you done? Or what did you do when she was younger?

Scott Benner 58:00
Sure. Sure. So, uh, so we went through a couple of iterations. When she was younger, younger, she was using just you know what, on the pod and she would, she'd go to the nurse. You know, when she was in second grade? She'd go to the nurse's office send me I couldn't see your blood sugar back then. Like there was no share feature in in Dexcom, even when she had it. But yeah, they they give me the number they test her to I'd tell them how much insulin to put in, they'd put it in. She'd come back number of hours later and test again. And that was before. That's before CGM. Once CGM came, then okay, now you know, they could see that we worked off of that and then eventually share showed up. Gosh, do you know that I put I made the phone company or the my internet provider somebody they used to make these like Wi Fi repeaters or something like that, that were of cellular. I made them install that in her classroom for two years. Oh, nice. We Oh, so on the pod share

Amanda 59:05
you taught you're telling me that I'm the crazy one.

Scott Benner 59:07
Hey, do you like the podcast? I do that leave me alone. Okay, Jesus, God be nice. I'm already married. Amanda. I don't need this from you. Okay. I get to teach you you're on the podcast. You'll be nice to me. I'm the host. That's how all this works. Now. I'm just kidding. I'm sorry. But we did that so the back then so Dexcom share had a way to get out because the school didn't have Wi Fi right. And then when that no longer became necessary, etc, etc. At a point you're really talking about is the point where your son's out right now he's got a Dexcom it's a cheese six you can see his blood sugar's in real time. He's wearing an algorithm at that point and Arden's life. There's it goes in spurts. There are times when it just you don't have to talk to her at all. You know, and then there's times where things go wrong or you know, you're heading out the door for school when you realize oh, we should change that pump last night. You know, like then that needs Some more. There have been times where I've, you know, I've talked to her every day before gym class. And now I don't really know when she goes to gym to be perfectly honest. Yeah, but so you know, the thing you need most. It sounds so counterintuitive, but you need the honeymoon to end so that there's stability.

Amanda 1:00:20
I agree. Yes.

Scott Benner 1:00:22
And then you'll start seeing things that make sense. I mean, you know, for diabetes, right, and you'll be able to make more meaningful decisions. But for a kid who's in this situation, you're doing really well, exceptionally well. And I find that nobody tells anybody that and appreciate it. Yeah, no, no, yeah, really great. I'm like, what are we talking about here? Most spikes only to 150, sometimes 180. They come back down on their own half the time if they don't you know how to correct them. Seeing lows maybe around us activity more than anything, but we're calling low 65, which there'll be a day where you won't think of as a momentary 65 is a problem. I don't want his blood sugar in the 50s anymore than you do. And so, but that's only happening here and there. He's got diabetes, so Right. Might think that's gonna happen now. Does he drift into the 50s? Or is he falling through the 50s? It sounds like he's drifting into the 50s.

Amanda 1:01:19
Most of the time drifting. Yes. Occasionally falling.

Scott Benner 1:01:21
So. So what that mostly sounds like is that it happens and excuse me. This is it. The college flu, I have the college flu. Oh, talking so much. My throat got dry. I'm on this intermittent fasting, which by the way, everyone should do just saying. But I don't drink anything with flavor in it before my fasting window opens. Oh, okay. So the water's not quite doing it for me this morning. Oh, I wish I had something else. I could do a black tea, but I didn't have time. It's not your how's it going? The

Amanda 1:02:00
intermittent fasting.

Scott Benner 1:02:01
I think it's saving my life. Oh, well. Good. I think it's amazing. I think that I think everyone should eat in at least an eight hour window during the day. Yes. It's It's really wonderful. Like, just I wish I knew about it sooner. Awesome. Anyway, have a great episode about that. Oh, okay, hold on a second. Let's pimp the episode inside of the inside of your episode. Do it. I'm pulling up the the episode number right now. It's number 516. How we eat intermittent fasting. Okay, it's with a woman named Jen Stevens. She's got this. She writes intermittent fasting books and has a podcast about it. Interesting. Very cool. So basically, you know, for a person who doesn't have diabetes, you're by eating inside of this window. You're significantly lessening your insulin needs in the other window. Right. And that is just huge for a lot of things. And I came to realize while I was talking to her, the Artem basically does this too, because she's not a breakfast person. Okay, yeah, it's so Arden almost is like a 12 hour off eater. Like she doesn't, you know, she doesn't eat from later at night. I mean, 1011 o'clock, usually, to almost noon the next day. Wow. And that's how we know how good her her settings are. Because she's sure she's super stable, and her algorithms not going crazy most of the time. Although, again, for people like who are considering this stuff for the future. On days, when it goes wonky, the algorithm gets ahead of it. And you know, you get to live a normal, a more normal life where you're not so good. Yeah, worrying all the time about am I getting high? Am I getting low? Do I have to bump do I have to nudge now back to your original question when we were bumping and nudging? You know, how often did I talk to her? I don't know. If four, four times a day maybe it was like Hey, Bolus point two five Hey, set a Temp Basal for this. About like that. I was rudimentary, rudimentary. Oh, damn it, I went down. So I know rudimentary is the word but how do I add a y to it? Or is that not? Oh, I was really good. That's a word not a word. I was rent. I was doing a simple version of, of an algorithm. So I was Yeah, I was being a simple version of an algorithm. Take it away here. Put it back here. That's what you're all doing. When you're bumping and nudging. You're just you're being your own algorithm. A little bit.

Amanda 1:04:37
Right. So, so good. I mean, how neurotic were you with it? Like would you let her ride higher in the 150s 160s? Before you bothered her to have her do something about it? Or were you trying

Scott Benner 1:04:46
to I mean, if you're looking for my specific ideas, I treat blood sugars over 120 that I think aren't going to go back on their own and I would give her her carbs at school under 80 At home, okay, at home, I wouldn't do it until, you know, right? It's 70 probably

Amanda 1:05:05
okay. And you've always done that with her when she was younger, too.

Scott Benner 1:05:09
I mean, your years were kind of your parameters in your head. You're confusing me now with me then. Like the technology, the technology didn't exist. And my thought process didn't exist. So back then I just ran around, like with my hair on fire.

Amanda 1:05:24
Right? When she was like, 1112, she had technology, didn't she?

Scott Benner 1:05:27
Yeah. Okay. So when she was 11, and 12? Yeah, I mean, once. So what I find is to broaden the conversation. Yeah, once you've noticed what stability looks like, and you can achieve it on purpose, then a 70 doesn't scare me. If it's falling, I obviously would feel differently about it. But sure, a stable 70 Isn't by chance. When that happens when your settings are good, and you're making purposeful boluses you understand the impacts of different foods, then 70 might be a huge win. Like I wouldn't I wouldn't correct a stable 70. Now, you know, back then what I have you maybe but with like, a gummy bear or two? like I would in my mind, I would just try to make it 75. Now, if it kept trying to fall, then that's different. Right, then I might be more aggressive about it. It's super interesting in the beginning, how people want to know how much how long tell me how much tell me how long tell me how you What number do you do this at? Like, it's no, it's because you have no,

Amanda 1:06:31
there's nothing to go by.

Scott Benner 1:06:33
You have no context. No experience. Yeah, no, you have no context. And so you're scared that everything that's happening is about to be really wrong. That about right. Correct. Yeah. But so then the answer to that question is the only thing that fills that gap is experienced in time.

Amanda 1:06:51
I know which I'm so bad at that I'm an instant gratification kind of person.

Scott Benner 1:06:55
Mm hmm. Well, yeah, that's not gonna come with this. I know, Gosh, darn it. The good news is, is that you should probably try to enjoy this time a little bit. Okay, there's gonna be some big adjustments coming. And then after that, you should find some stability just in time for him to start growing hair on his

Amanda 1:07:18
right.

Scott Benner 1:07:21
This will all start over again. Oh, and then it's just gonna be a way it's just gonna be a ramp up, then. Yeah, you're bigger. You know,

Amanda 1:07:29
God was like doing some funny things when he gave us this, this disease, I think or for me, specifically, because I was a person who beforehand, I, I'm a health nut, I guess you could say. And so sleep for me was extremely important. Like, I would make sure that I got eight hours of solid sleep every night, enter diabetes. And then with diabetes, there's nothing that's concrete, it has to be very fluid. And I am very, you know, black and white for the most part and need to have an answer to everything. And this is the exact opposite. So yeah, it is testing me intentionally, I think

Scott Benner 1:08:04
last night, get me to chill out. Yeah, last night, we spent, I probably started cooking at like three in the afternoon. So I shopped in the early afternoon cooked all night, because I'm like, we're taking a bunch of food to my son at college. I don't know if that parks in here. So just for context, and spent the whole night doing is fairly exhausted by like the time 1030 or 11 o'clock came around. I'm 50. And, you know, I sit in a chair all day for my job. So I'm pretty exhausted by then. And still because of diabetes and all this, I think I was up to like 130. And then I popped out of bed at eight to do this with you so that I don't get in a car and drive two and a half hours with that food, to drop it off to my son. Basically give him a hug. Ask him how he's feeling and get back in a car and drive two and a half hours home because he has no time to talk to us today. So Oh, goodness. So nice of you prior to that, no, the point wasn't how great we are. That's obvious. That's not what we're talking about. The point. The point is, is that I have learned to deal with less sleep because of diabetes. I don't want I don't like it. But I know how to do it. Now the good thing is the algorithm should be letting you sleep. Are you not sleeping?

Amanda 1:09:18
No, it does. It definitely does most of the time. Yeah. But I mean occasionally, like when he had that cold, I had to mess with it through the night or occasionally I'll get his dinner wrong and it won't come back down where I want it to be. So no, yes, with the pump. I would say sleep is definitely much better than it was prior to getting the pump and we didn't have that long in between but and I think that the sleeplessness, really more is just my own anxiety around it. So I just sleep with one eye open more than I ever did. And I think that, you know, like things going off on my phone waking up more quickly or a little sounds outside and then I'll wake up and I'll check the Dexcom just to make sure that he's still good It's more than that really than having to actually treat anything. Yeah.

Scott Benner 1:10:03
So that happens to Kelly. Like now that Arden has diabetes. Kelly could have the flu and pneumonia, and have been up for four days straight and finally fell asleep. Then you hear a beep and she was what is that as Arden? Okay, like Adam, out of a deep sleep. Yep. Now I'm the one I opened all the time. Yeah. Now I'm normally the one that handles it, but still can't not hear it. Right. It's really interesting, whereas I don't really hear that anymore. Really? Yeah. I'm bad hearing it at this point. Though, I'm I don't mean that I can't hear. I don't mean that I can't hear the noise. I mean, that. I'm not like, what's that? Like? It's it. I just, I'm, I don't know, I have I'm comfortable enough about Arden's settings and how things go that I don't I don't pop up like a lunatic anymore. Yeah, yeah. So hopefully I'll get there one day. Yeah, you I'm sure you well. You know, it. I mean, honestly, forget, I'm sure you will. You should know, Amanda, based on the people who have spoken to in the past that this is gonna go really well for you. You just need the time. Yep. Yeah. And then you gotta chill out. You don't smoke weed or anything? You know, maybe I should. I'm saying I'm not a proponent. Like I'm not telling you to. But you gotta calm down. You know what I mean? Yeah, yeah, cuz we're not married. I can say that to you. That's true. Yeah. But let me just here, I'm gonna write down the time. That's where we're at here. So I can go back real quick and edit this out. You just gotta chill a little bit. You're making it? No, no, yeah. And everyone listening who identifies with you. You guys all got to hear that they need to just chill, calm down. It's gonna be okay. Now listen, don't get me wrong. If your kids blood sugars going from 40 to 404 140. You all need to figure something out. But if you're in this situation that Amanda's describing her, what was me 6.181, C. etc, you guys got to find a way to realize that the rest of this is experience. And that you can cannot rush getting experience. So okay. And mine only seems so much greater than yours, because of my time, but also because of all the conversations that I have. So I have like a Master's class and diabetes from talking to people. Right? The rest of you don't have that. You're trying to get it by getting immersed in your own situation, but your own situations not. It's not always real. Like you don't miss meaning you don't always understand what's happening. So you start formulating thoughts and theories based on you know, bad numbers almost. Right, you know? Does that make sense? Do you find that happening where you start, like flying down rabbit holes trying to

Amanda 1:13:01
Oh, 100% I'm very reactive, for sure. I don't let things ride probably long enough. A lot of times, because I just want to fix it.

Scott Benner 1:13:10
Yeah. Okay. Yeah. Sometimes you got to see it. So you know what to do with it? Yeah, I mean, sometimes it's kind of the key to the whole thing, like things have to go wrong, so that you understand how they go wrong. Because then once you have the tools, you know where to put the tools to stop it from going wrong. Yeah, and control IQ is I feel bad. Like, I mean, it's I've never lived with it. So right. I don't know. Yeah, you know, it's okay. Yeah, based on based on what I've learned from looping, you know, if you're, if your insulin sensitivity is good, if your Basal is good, if your carb ratio is good, and your Pre-Bolus thing, you know, you should be somewhere along where you mean to be. And then you have to understand that other piece with the glycemic load index of foods, like you can't just eat the sofa and expect something different not to happen. You know what I mean? And I'm not judging anybody. I mean, I think that's fairly obvious from the podcast, right? But right, you know, some people are, are sitting down with a, you know, a piece of baked chicken and 12, green beans and a couple of almonds, and some of you are trying to eat, you know, stuff. That's not really food. And then, right, and I'm not saying you can't figure out how to Bolus for it. I'm saying, don't be surprised when it's harder. That's right. That's all. I don't know that you're going to change his his palate when he's 11. Exactly. I would also tell you,

Amanda 1:14:40
and I also don't want him to feel like he, I mean part of it. Listen, I'd love for him to eat healthier foods in general, but part of me doesn't want to have to have diabetes be like I don't want it to be a punishment for him. And I don't want to have to say like, you can't eat this because it doesn't make your blood sugars look good or whatever. And and I want him to feel like he can do whatever he wants to. He doesn't have to be limited by diabetes. But I'm hoping that, you know, as he gets older, he starts to kind of figure some of this stuff out and wants to make some changes. But I don't know. We'll see.

Scott Benner 1:15:11
No, I agree. And I agree with you, too. And that happened for Arden. Like, I've told that story, like we left the endo appointment one time, and she just, she's really a little kid. She's like, is there anything I can do to help with this, and I was like, you could stop eating cereal until Daddy can figure this out. And she's like, okay, and she just stopped eating cereal. Rice, and I was, and it, it was the variable that was too big and too impactful for me to figure out with the amount of experience and tools I had at the time, like, I just couldn't, it was too much for me, I couldn't wrap my head around everything that was happening. So when we took away that impact, and simplified some of our foods, then I was able to see it better. And then I was able to take what I learned and then apply it to cereal. Yeah, and then, you know, that's it, because sometimes there's some of those insulin needs are so crazy. Mm hmm. Like, it's hard to make that leap when you're Bolus thing. You know, like, if Arden went to I think she went out and got like a bowl the other day like from Moe's so I don't know, it's, it's a shell. And it's, you know, they put in chicken and rice and corn and onions, and like guacamole and all this stuff. And yeah, we just randomly Bolus like 85 carbs for it. I don't know how much is in that. I don't even know how much she's gonna eat. Right? And there are times when ardonagh Wolf the whole thing down and there's times when she gets halfway through it. And she goes, I don't want any more of this. So I'm like, Yeah, okay, like, all right. So you just, you just have to get get the insulin in there ahead of it, and then work backwards off of it instead of forwards. So instead of, instead of meeting the food with the right amount of insulin, and keeping everything stable, you throw it around, you throw in an amount that the food can't possibly overwhelm. And then if she doesn't eat enough for it doesn't impact as hard, then you can address it with more carbs later or hopefully taking by taking away Basal insulin or something like that. Right. Okay. It's just kind of how I think of that, that bigger stuff, because I would rather I'd rather be ahead of it than chasing it. For sure. Okay, yeah, I get that. So do you have any questions? And don't be don't be like, if you have questions, now's the time. Let's go through them.

Amanda 1:17:30
I did write some things down. But I actually think that we were looking through them. So for you, if she if you get a Bolus wrong, and she does start to go above the number that you want her to be at how long do you wait before you address it with more insulin to see if it's because there's a lot of times with the CGM where it looks like I'll get a straight arrow up and then the next reading is a diagonal and it only bumped up by another two points or something. Do you know what I mean? Or even with the lows, where it looks like it's gonna go straight down? And then the next reading? It's only two points, lower and diagonal arrow and it kind of tricks you?

Scott Benner 1:18:10
Yes. So you're probably in a situation where it's possible that the pancreas is like, oh, gosh, what's going on here somewhere? Yes, outside of that scenario. When I first started doing this back in the day, it was 45 minutes and an hour and a half is where like my inflection points kind of where now I can see it. So there's a sharpness to the rise on the CGM. That indicates to me this isn't coming back. Okay. And then I just put in more. I got it. Okay. Okay. But it's, for me, it's on the I use the three hour graph. And I look at the, for what you're asking about specifically, I look I look at about the last 10 or 15 ticks, I guess. Yeah. And then there's a sharpness to it. That just says, oh, hell we missed, and you learn to see what it looks like. Okay, and then I apply an amount of insulin that I usually randomly choose. Yeah. Okay. Fair enough. Yeah. Sorry about that. But it's, you know, excuse me, it's usually some multiple of her Basal rate. So that if I have to bail on it, so if I've made a new Bolus and and five minutes later, you get that thing where like, it just stops and levels off. You're like, Are you kidding me? Right, like so some. Sometimes I'll try to trade the basil for the Bolus, like I just put in this one unit Bolus. And then it suddenly levels off. I might shut the basil off for half an hour just to try to like horse trade a little bit with the gotcha. But that's also a slippery slope. You don't want to be finding yourself doing that constantly because cuz then there's bigger,

Amanda 1:20:02
because the timing of those two things is probably not exactly in line with each other.

Scott Benner 1:20:07
No, they're not. Yeah, you're just doing your best to try to make a couple of overlaps. That'll stop a low later. Yeah. But I've also done that and shut off our basil and five minutes later texted her back and been like, oh, hell put the Basal back on. Sorry. Yeah. You know, I've also I've also made incredibly aggressive policies that literally 30 seconds later, I'm like, pushed up pushed up. Just kidding. It's not no, don't do that. When please respond. Damn it. And then I know, I inevitably get back a text that says, Too late. And I'm like,

Amanda 1:20:44
Oh, that's good to hear that you do things like that, too?

Scott Benner 1:20:46
Yeah, sure. It's not a I mean, did you think this was a perfect science?

Amanda 1:20:51
Yeah, I don't know. You got it down pretty well, it sounds like,

Scott Benner 1:20:54
um, yeah, I do. But again, it's time it's willing to, it's willing to be able to twin to talk about it like this. Yeah. Like, I think this conversation is really cool. Because this is the exact kind of stuff that I think people talk about privately, they would never say out loud in public. Right? Because it flies in the face of most things that most basic concepts that you mentioned earlier that your doctor gave you that are really not very helpful. Once once you get into the minutiae, right, you know, like, exactly count your carbs, you know, put the insulin in. Think about what they really tell you, right, like get, count your carbs, put your insulin in three hours later, check your blood sugar, see where you're at?

Amanda 1:21:40
That's it. I haven't talked to our endocrinologist. I haven't called them or talked to them for advice on changing anything since our last appointment over three months ago, because I realized that they were just guessing they were 100% guessing.

Scott Benner 1:21:51
Okay. Yeah, yeah, they're like, ah, you know, so you're getting low every night at 2pm. A 2am. Let's turn your Basal down at 2am. Like what? Yeah,

Amanda 1:22:02
yeah. And I saw it like, I knew I could tell that they were totally just an educated guess at that. But I mean, just guessing. So I'm like, Well, what I'll guess like, oh, I can do that.

Scott Benner 1:22:12
Listen, I'm gonna say something, Amanda, that maybe won't rub people the right way. And I'm not just talking about the medical profession, but in general, right now. World goes to hell in a handbasket. Right? They're coming in by planes, tanks are crashing into the shores. How many people you hunker down with who you think these are the people who can get me through? How many do you know?

Amanda 1:22:33
I'm one?

Scott Benner 1:22:35
Yeah. Okay. So now you're randomly calling a random doctor's office that you went to, because the hospital that you ended up to with when your son was diagnosed, told you about this endocrinologist? And you're talking to the lovely person that answers the phone, who's 20 years old, who then moves you on to the person who's been out of school for three years and doesn't have diabetes? And you're asking them a pointed question about a Basal insulin. Right? And even if they know, how are they really going to know they're not there? They don't have this, like this thing that we did that for this last hour. They don't have they don't have this critical thinking around the minutia stuff. Right. So it's unfair to them on top of the point that I don't know 10 People who I would trust with my life, sadly, and I bet a lot of people and I'm not saying you're all prop like people, I've met her like, I just don't know you well enough. You know, like, this is a weird thing to be asking someone. So I joke about me being a stranger from the internet. But how many hours? Have you heard me talk about diabetes? Countless a lot. Right? So yeah, I've listened to a lot. Yeah, I'm not really that unknown to you. You know, exactly. Right. So. And I'm not saying there aren't people out there there, obviously. I mean, Jenny's like, you mean, I've spoken on the stage with me. And I felt like I held my own. You know what I mean? But I also wish, if you said to me, Scott, I can ask you or I can ask Jenny about something I might be like, I might ask Jenny. You know, like, I don't know. Yeah. And there are times when Jenny will text me and be like, What do you think of this? And we'll talk back and forth sometimes. And I know, I know. She respects me. I know. I'm in that space a little bit. Yeah. But who else is there? Really? It's not even even the doctors. I mean, I don't know how it works in your health system. I I'm not sure I could pick Arden's endocrinologist out of a lineup. Right? Not kidding. We never see her ever. Mm hmm. And her nurse practitioners, you know, terrific, but I don't remember the last time she gave us any like, pointed advice about insulin. Sure. You know, she says things like I'm concerned. They say I'm concerned about this low here, which I'm starting to think isn't is a liability thing. Yeah, because if you go that's not a low that is a compression low they go okay. And that's it. We're done talking about it. Now. You I think that's liability that they have to point it out to you

Amanda 1:25:03
for 100%. Yeah, I'm sure it is right. To be able to chart it.

Scott Benner 1:25:07
Yeah, I think that's exactly what's going on. So I don't know what's happening for like, I mean, I've been in appointments where I'm not sure if I'm being like, if that's the conversation we're having, cuz it's me, or this is what the conversations are like. And I would tell you that if I wasn't me, that those conversations wouldn't be helpful. Yeah, you know,

Amanda 1:25:29
it's not Yeah, it's they're very, very generic. I feel like but I mean, I understand it.

Scott Benner 1:25:34
Yeah. Your Site feels good. You're doing great. Good job. Yeah. Blah, blah. Like all right.

Amanda 1:25:39
Right. Collison, urine, DK, or

Scott Benner 1:25:42
Yeah. Can you tell me how many minutes after I miss on a Bolus? Should I readdress this three hours? Oh, great. Perfect. Don't stack? Yeah, don't stack your insulin. Why? But I mean, it's a bunch of years. 300 You can't stack your insulin.

Amanda 1:25:58
Right. Right. Yeah, exactly. I have one more question for you. And it's probably another more of a neurotic question, but I'm going to ask it anyway. So the difference between changing like doing a Temp Basal adjustment versus an extended Bolus when would generally speaking, why would you use one or the other?

Scott Benner 1:26:22
I like a Temp Basal. Let me get some water. I like a Temp Basal in a karbi. situation. Okay, so if you're going to, you know, if it's I don't know, Thanksgiving Day, and there's food out on tables all day. If your Halloween Yeah, well, Holly last sell sugar, a lot of simple sugar, that's harder to think about, you might get a lot up and down at Halloween, if you're too aggressive. On a day where you're running around, and somehow you eat pizza for lunch, and then grab Chinese on the way home, like you don't like that kind of a situation or you're just having a meal, where, you know, one hot dog turned into three hot dogs, and there were chips. And there were all this, I might create a blanket of basil overtop of the timeline. That is the impact of the food. Okay, yeah. And, you know, just to, you know, because in my mind, the basil is sort of like a blanket that's holding down on your body's function, right? Like, it's, let's be clear, Basal is just to control body function, right? It's not for food, but you can maneuver you can manipulate it and you know, to use it for food. So if your kid needs point two, five, to control his body needs, right. And then suddenly, he eats a bunch of hard or long impacting foods, I might then want that pressure that's coming down from the Basal to be heavier so that when that food starts pushing up, because it's going to push up over such a long period of time, I like there to be a more even coverage of heavier Basal for something, okay? Because, because when you Bolus for it, you're going to get that, you know, nothing happens then an influx and then, you know, that's about it. Like right like the insulin peak. So you you've got that pressure at one time. I like to see it across the whole thing.

Amanda 1:28:24
Okay, so then we went about an extended Bolus and

Scott Benner 1:28:27
Bolus. I don't love extended Bolus, but if I was gonna use them, I would use them for you know, a thicker, you know, thin crust pizza, not so much. But a thicker crust pizza that has, you know, maybe meat and cheese in it. And so you know, you're gonna get that fat and protein rise later. But you could also just do the good also listen to the episode about the fat and protein rises and just make a pinpoint Bolus for the fat and protein later to or for the fat later to excuse me. And I used them a lot at school before to Pre-Bolus when her blood sugar was lower. So

Amanda 1:29:11
if Oh, right, okay, so give a smaller percentage of current and then yeah,

Scott Benner 1:29:15
so Arden's like, you know, it's time to Bolus for lunch. And we need some sort of a Pre-Bolus butter, blood sugar 78 And she's got 45 carbs in our lunch, and that's gonna end up being you know, 11 units of insulin like not super comfortable giving Arden 11 units of insulin 10 minutes before social studies ends, and then she's got a walk through the school and then you're hoping she starts to eat on time, etc. So, if that in that specific scenario, if she was like 78, I might do the 11 units 0% up front, the rest over 30 minutes. So that these 11 units are going in pretty aggressively, but not like a Bolus over 30 minutes. So then To 15 minutes later, when she sits down to eat half of those 11 units are in. Right. So I do sort of get ahead of it like so I've used it like that before and with different breakdowns like, you know, if she's 85, I might do 20%. Now the rest over a half an hour. So that's a way right, I'll use an extended Bolus in a way that it's not really meant to be used. I'm just, I'm just using it as like a time release Bolus. Gotcha. Right. That makes sense. Yeah. But I mean, those are, those are some of the places you might do it. But they're also very hit and miss. And they can be they can be frustrating while you're learning how to do them. Yes, you know, so I agree Friday,

Amanda 1:30:45
I tend to use the extended Bolus a lot. Because with the control IQ, I turn that off, and I just don't have competence, especially when he's at school that he's gonna respond quick enough to fix something that needs to be fixed. So I just use an extended Bolus, as opposed to a Temp Basal a lot when he's at school.

Scott Benner 1:31:05
Okay. And it works for you.

Amanda 1:31:08
I mean, it seems to right now, anyway. Yeah.

Scott Benner 1:31:11
Well, I mean, listen, in the future, it'll just have more basil, you know, a stronger basil. And so I don't see why it still wouldn't work from what I understand from talking to people. The bigger problem with to generalize boys, isn't it? You know, obviously, the, the hormones are going to be one of them. But that actually might not happen till they're a little older, as as drastically as like, unlike the girls where you could see it, like 1112 13 years old, and they're, the bigger problem is when boys are just, you know, classically boys? Yes. And they're just like, I don't care. It'll be fine. Or I'll just run through the wall. Like that kind of stuff. You know? Yep. That that might end up being the more challenging aspect of this at some point. Mm hmm. So yeah, I don't sure I can see that. Yeah, I think boys will be boys is a thing for some sort of a trail of real. Yes. Yeah. It'll be, it'll be fine. Don't worry about it. Yeah, when my wife and I were first married, we took a road trip to Washington, DC, for navigation systems. And before like it, like you needed a map, if you wanted to know where you were going back then. And we get in the car, and it's nighttime, like who went on a Friday afternoon after work? And they were driving and it gets dark. And she's like, you don't have a map? And I was like, no, she goes, How are we going to get there? I'm like, It's Washington, DC will drive south on I 95 Until we see a giant white building, and then we'll get off the exit and look for the streets of the hotel. Right. And she was mortified by that. Like, I we arrived at the hotel, there's nothing eventful about the trip whatsoever. And she got in the bed. And I was like, are you alright? She's like, I'm just I'm very anxious. And I was like, about what? And she's like, we didn't know where we're going. The whole time. I said on the whole time. We knew we were going to Washington. I was there's this main road. It's, you know, it leads right to what there's a giant white dome. It's lit up like we couldn't possibly what about signs? Like you don't think at some point, there's going to be a sign that says Washington DC. And, and that was my extent of being prepared for that. And I'm trying to say that that theory wrapped into a 14 year old China trying to figure out how to Bolus before he goes out in the woods and rides a motorcycle might be fun. So

Amanda 1:33:34
yeah, yeah, exactly. Yeah. That's pretty much my life. That's where I'm at.

Scott Benner 1:33:40
Alright, was this in any way helpful to you? Absolutely. Really? Okay, good. Yeah.

Amanda 1:33:46
Yeah, really? Honestly. I'm glad. Yeah. I mean, I think it's helpful for me to hear that what what we've got going on is like, it's fine. Because you don't see. I don't know, I don't you don't know what you don't know. We don't know a lot of other. Well, I mean, so we do know, obviously my niece but they're just as new to this as we are. And then the only other person that we know that's in my son's class is was diagnosed three months ahead of Connor, my son, Connor. So you know, we're all trying to figure it out together. And outside of that, I don't really know anybody that's been doing it long enough to know what's to be expected.

Scott Benner 1:34:17
Yeah. Hey, I want to make a little PSA right here. Don't everybody send me a note and want to do this? Okay. Please. Thank you, right. Yeah. No, no, no, Amanda, that would, but Amanda doesn't know about herself is she was the right blend of neurotic and normal for this conversation. And I figured that out while I was talking to her. So I didn't think you weren't going to talk over me the whole time. You were going to be okay with me doing a lot of the talking. And I knew you would be good for this. So also, here's the thing. If you feel like oh my God, I need this conversation to a man this conversation will go exactly the way your conversation will go. So there's nothing particularly special or that much difference between how Amanda's feeling and how you may be feeling. If you're right now saying, oh my god, this is my life and listening to this. Yeah, pretty much whatever we said is going to apply pretty well to you. Yes, yeah. All right.

Amanda 1:35:14
I appreciate it very much.

Scott Benner 1:35:16
Oh, it's my pleasure. It really was. I don't want to thank me. I thought this was terrific. I thought it was great for a podcast too. And I was happy to help you. You know that I wanted to do this because we're doing it on the day. I don't usually record. Yes,

Amanda 1:35:29
I do. And I really appreciate that. No,

Scott Benner 1:35:31
again, you're not supposed to say you're not listening. You're not supposed to thank you for it. I'm just it's an indication of how much I wanted to do it. Because if I didn't want to do this, we definitely wouldn't be doing this today. That's just true. Okay, so hold on. I'm going to ask a couple more questions about your husband's shaving but I want to do it privately.

First, I want to thank Amanda for coming on the show, and having this conversation in front of all of you. And I'd also like to thank our newest sponsor, US med. There's no need just no need for it to be difficult for you to get your diabetes supplies. Us med.com forward slash juice box or call 888-721-1514 I'm so happy to have an advertiser with a phone number now, because I'm like doing an impression of like, infomercial like voices from when I was a kid 888 Anyway, oh, touched by type one.org Don't forget them. Great sponsor wonderful place. Go check them out. This was kind of a long episode, so I won't dilly dally here at the end. I'll just say thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. And I guess I will note that a lot of the stuff that I talked about in today's episode is it exists in detail in the diabetes Pro Tip series that begins at episode 210 In your podcast player, or can be found at diabetes pro tip.com, and juicebox podcast.com. Also, if you're See, I'm going online now, I know you're laughing at me, I don't care. Also, if you're in the private Facebook group. There are these great lists of all the series in the podcasts, the pro tips being one of them. You kind of go up to the top and there's a featured tab. So first of all, it's a private group, you're gonna have to answer a couple questions to get in. Once you're in there. You're going to be with about 23,000 other people who are using insulin just like you great place completely free, featured tab lists of all the series, including the pro tips. Now I'm really leaving goodbye

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