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Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

Filtering by Category: Juicebox Podcast

#214 The Frozen Urine Part of Diabetes

Scott Benner

Isabel is from a land down under.….

Isabel is a nurse from Australia who not only has type 1 diabetes but also helps others to live better with type 1 at inrangediabetes.com.au.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon AlexaGoogle Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT


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 everyone and welcome to Episode 214 of the Juicebox Podcast. This episode of the podcast is sponsored by real good foods Dexcom Omni pod and dancing for diabetes. There are links to all of the wonderful sponsors in your show notes and at Juicebox podcast.com.

Today I'll be speaking with Isabel, she's a nurse from Australia. Well, I think she's from Scotland, but she couldn't be from New York, it's hard to tell she's a bit of a jet setter. Really, she was when she was younger. Isabel has type one diabetes, she's the mom of two adorable children, one of them who you're going to meet at the end of the episode. And she runs a business in Australia called arrange diabetes, you can check that out at in range diabetes.com.au. That's right, we have so many Australian listeners at this point, I have to do episodes just for you guys. Thanks for that. By the way. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before becoming bold with insulin or making any changes to your health care plan.

In my mind, you understand in my addled American mind, you live in a what I'm assuming is a shack made of three boards and analogous tail.

Unknown Speaker 1:24
I'm close to that.

Scott Benner 1:30
Well, then, in fact, I'm sorry.

Isabelle 1:34
I enjoy my shock.

Unknown Speaker 1:36
That's excellent.

Isabelle 1:40
So I'm Isabelle I am a type one diabetic and have been since I was 10. For for 24 years. I'm a mother of two little ones, one two year old and a three month old. And I live in Australia.

Scott Benner 2:03
Now you're probably gonna be fairly impressed is about when I tell you that you're 34 years old.

Isabelle 2:09
I'm very impressed. Very good. Thank

Unknown Speaker 2:11
you very

Scott Benner 2:15
well, so Australia, but you're Are you from

Unknown Speaker 2:18
Australia are

Scott Benner 2:19
you from?

Isabelle 2:22
I'm actually from Scotland. So I moved to America when I was four. I lived in LA for four years and New York for four years and then lived in Sydney, Australia for four years and then moved back to America for a year. And then.

Unknown Speaker 2:45
So we'll

Scott Benner 2:46
get to that in a second as well. But I think your your microphone might be touching your clothes, though. So I'm getting like,

Unknown Speaker 2:53
like a little Okay, yep,

Scott Benner 2:54
yep. So. All right, cool. Okay, so I could hear you fine. I just there was a little bit of scraping in the background that well, at some point while we're talking bother me more than anybody else, and I'll just be sitting, you'll be talking. I'll be thinking I can hear it hitting your sweater. Okay, so obviously, I didn't keep up as much as I would have liked. But you were born in Scotland. Yeah. Well, Los Angeles. moved to New York.

Unknown Speaker 3:23
Yes to Australia.

Isabelle 3:27
Yep. And then back back to New York and back again.

Unknown Speaker 3:32
Yeah, so your parents

Scott Benner 3:32
or you? I'm one of you. is an international gangster. Is that correct?

Isabelle 3:40
Yep, totally. No, my dad worked for the Bank of Scotland, which doesn't really sound like it means you would travel a lot but but we we get he got promoted every every once in a while. And we we moved.

Unknown Speaker 3:57
Moving around.

Scott Benner 3:58
I prefer to think that you were you were running on your father's gambling debts. I think it's a much more exciting story. I'm gonna tell myself in my head as we're talking. That's really crazy. Now, how did you find being transplanted so many times? I guess the first time when you're four, do you have a recollection of thinking? Well, none of these people speak correctly?

Isabelle 4:22
No, I have no recollection of that whatsoever. And even next move nothing next to moves nothing but it was when I was 12 and we moved back to New York. That was hard. And everyone just kind of ignored me.

Scott Benner 4:47
Here's why. If I can guess on the on the just at the onset, you have an Americanized Australian Scottish accent which you can actually hear or parts of while you're speaking. It's usually Start you start off Scottish you trail off Australian and everything is just a little American as you go.

Unknown Speaker 5:06
I Yep. So I hear very strange

Scott Benner 5:10
you hear it or not, I'm sure you don't hear it. If you're in the Orlando, Florida area, it's time to start thinking about the dancing for diabetes touched by type one event that's going to be on May 18. go dancing for diabetes.com. To find out more that's dancing the number for diabetes.com I think you're going to know one of the speakers. He sounds a lot like me.

Isabelle 5:34
I can't hear it at all. And I usually I was gonna say I usually can hear accent very well. But then if I hear an accent that Scottish or one that's an American, I'm, I can get it right away.

Scott Benner 5:51
So to the listeners, I have a lot of listeners on the west coast. We're originally from the east coast, I get a ton of notes that tell tell me that the podcast makes them feel comfortable because I talk the way they grew up. And yeah, every time I get that, I think Oh, that's so nice. Then the second thing I think is I don't speak any specific way which is completely untrue. No, none of us like that. The other thing is my brother in law is from Scotland, and has made no real effort to in any way. Americanize how he speaks. And when I speak to him, I stare at him. I listen incredibly intense,

Unknown Speaker 6:31
picked up.

Scott Benner 6:33
Really here as I as he's talking. And and I just I try so hard. And I'm looking and look. And sometimes you hear key words, and then you just get to the point you go.

Unknown Speaker 6:46
Because I don't know what he's saying. You assume something has been said.

Scott Benner 6:52
Yep. Fascinating. Now his wife hears him perfectly. And she's from you know, Pennsylvania. So I maybe if I lived with him longer, I would figure it out. But nevertheless, it just sounds like i i to me, and I'm not trying to be cartoonish about it. I mean, he mumbles nigh complete. Right? through what he's saying. He uses a lot of slang that has no no perspective for me whatsoever. And then he speaks very quietly, and then every once in a while just gets excited. This all sounds very familiar.

Unknown Speaker 7:23
Yes, yes, it does.

Scott Benner 7:26
Your father's speak sorry. He was able to pull it together to get his promotion at the bank, I guess.

Isabelle 7:31
No, he is. Uh, well, my friends think occasionally. They have difficulty here like understanding him. But I think because he was, you know, in the business world and whatever. He has quite an eye. Good. Understandable.

Scott Benner 7:51
It's funny how an international world changes everything. A friend of mine, just the other day pulled out his phone and he said listen to this voicemail. And he was he was left a voicemail by a colleague of his in India. And we have, I mean, to say that my daughter's best friend is Indian is not an understatement. Like there's a pretty big Indian population where I live and and I listened to that voicemail. And I said to him, I was like, I didn't hear three words. I'm sorry. And and how do you do your job. And he said, in the first couple of weeks, when I was at this company, I was, I really did have to sit around and intently. Try to like, slow myself down and listen, because he's like, you can hear once you can hear, you know, that's like, that's really kind of weird, but Okay, so you're an internet called jet setter? Who got back to New York when she was 12. And do you think it was because you were from somewhere else? And you had an accent that the kids kind of? Or did you? And how did you find that? Because you're two years into your diabetes at that point right?

Isabelle 8:51
away? Hold on. No. So a four out of four for when I got to La 456 and eight, moved away from America and I was 12 1314 1516 and then moved back when I was 16.

Scott Benner 9:07
Seven you had the trouble?

Unknown Speaker 9:09
Like with people Yes. That's when I had the trouble just going oh, that's Yeah.

Isabelle 9:13
When I when I moved back again. Yeah. And I I particularly wanted to go back to the same, the same area and the same school, obviously, because I was like, oh, I've got friends there. You know, it'll be easy. But, ya know, that was harder.

Scott Benner 9:28
16 It's a weird time to try to insert yourself into a

Unknown Speaker 9:31
circle. That's Yeah, no, I

Scott Benner 9:34
hear that. Plus, they probably thought there was a deadly spider hanging in your closet that you brought back from Australia, which is my entire understanding of Australia, by the way. And I've now I will tell you that the podcast is I don't think oddly but incredibly popular in Australia. I'm and yeah, New Zealand and that whole area gets a lot of downloads. So thank you, everybody. For that That's not why I had Isabelle on just to make you people feel better. That's not why I did this. Just kidding. It's not like, so you are a diabetes educator beyond having type one diabetes, is that right?

Isabelle 10:11
Yes, I'm a registered nurse and diabetes educator. So I've been doing my own private practice for three years now in diabetes education.

Scott Benner 10:22
So prior to that you worked in a hospital?

Isabelle 10:26
No, so that just means Yeah, but you can either be public or private, in Australia and public just means you work in a hospital and private private is that you've basically set up your own

Scott Benner 10:39
practice.

Isabelle 10:40
Practice. Yeah, okay, we're

Scott Benner 10:42
gonna probably stumble on a couple of words that aren't gonna are not gonna sync up here. But that's okay. So a doctor in your practice, or are you the are you the medical expert in the in the practice?

Isabelle 10:54
I, so I'm the only one in the practice. Normally here you would have? Well, no, not normally. But a lot of diabetes educators here worked out of a general workout of a diet, a doctor's practice. But I didn't want to

Scott Benner 11:14
basically set up shop on your own and you're just you're just focused on helping people with type one.

Isabelle 11:20
x? Well, no, type one and type two, technically. Yeah. Because, yes, too hard just to do type one. But, yeah, just basically,

Scott Benner 11:32
so you're supporting people with diabetes in Australia on you're very, by the way very industrious. Here's your two little kids. I had, I had trouble this weekend planning cutting the lawn was something else. Because I have children. I was like, I don't know if I could do both things in one day.

Unknown Speaker 11:47
But you were,

Scott Benner 11:48
you were obviously a little more industrious than I am. And, and so this is pretty cool. So what is your because your your email to me was, Hey, I found the podcast six months ago or so. And I'm enjoying it. And and I felt like you were saying you and I think about things very similarly. Is that right?

Isabelle 12:05
Yeah, yeah. And I don't know, I don't know where that stems from. And me I just taking each day as it comes, and, you know, not not thinking too much of, of, you know, the bad days, and then just just carrying on and that kind of thing, just sort of staying fluid with the whole thing. Yeah.

Scott Benner 12:29
So it's interesting, because genuinely, right before you and I got on, about an hour before we started, it's, it's very early in the morning where I am, and it's very late at night where you are. And so yeah, and by the way, thank you for staying up to do this is very nice. So Arden is in high school now. And she's been in there for about a month now. And I got a text this morning and said, My friend and I are going to go down to the cafeteria in between classes and get something to eat. Which is not something that has ever really happened before. You know, my son would do it all the time. But he'd be like, I jumped out of Spanish real quick and got a bagel or I didn't like, but she was suddenly saying it to me. And only about, you know, only about a half an hour before her blood sugar. Just It was crazy. It was sitting at like 110. And I was pretty happy with it. And I didn't think much of it. And all of a sudden I got 135 like straight up like it just the decks just said, Well, she's jumping up. So we pretty aggressively bolused for that 135 straight up. And you know, it leveled off at 140. And I thought, okay, I'll pull it back down slowly. You know, maybe we'll make another decision soon. But before I could do that, she texts me and she's like, we're gonna go get something to eat. And so I said, What are you going to eat? She said, I don't know. I've never done this before. And I was like, okay, so when are you going in a few minutes. I said, Well Bolus a unit right now. And she's like, okay, and before I knew it, I thought, Yeah, what are the odds that what she's going to get is that small plushies 140. And I wasn't sure that the small balls I used for the hour up was really going to bring her blood sugar back down. Anyway, so I texted her back. I said, Gina do two units. So she did to about 810 minutes later, I get a text that says I have a hashbrown which I said, Okay, is it bigger than your hand or smaller than your hand? And she's like, it's not, you know, like, right. So she tells me it's a little smaller than her hand. And I'm go, Okay, so she can't, she's got this great signal in the school, but it's just for tax. Like if you try to send a picture out of that school, it gets all like, bound up, you know, sounds like but forget taking a picture of it. Yeah, and beyond that, who cares, right? It's a hashbrown about the size of her hand you would buy at a school, and I thought to myself couldn't possibly be more than 25 carbs is my guess. Right? And so I'd given her two units she was 140. I figured that the point six I gave her for the arrow up probably just stopped the error wasn't going to Bring it down. So I needed another point seven to bring her back down. And the thing was, I was like, Alright, just double your bazel for an hour on top of this basically 2.6 that's already going. And right before you and I got on, I told her to cancel the Temp Basal. And our blood sugar's at eight nice and stable. Now that is the key, the core of what you're talking about just staying fluid and, and rolling with it. Because

Unknown Speaker 15:27
Yeah, I mean,

Scott Benner 15:28
imagine the other side of that. I'm 140 I want to go get a hash brown right now, most people would have just said no, like, right? Like, yeah, you can't eat now, like, don't eat now, because I don't know what's going

Unknown Speaker 15:39
on. Let's just not do this.

Scott Benner 15:40
Right? Yeah. So instead, I was just like, let's just be aggressive here. And we'll cut back if we need to. And if we have to, you know, if we have to cheat with some sugar at the end, because we got it wrong, too aggressively, better than you being 200 over eating this stupid hashbrown. Right. And I'm really thrilled with how it worked out. But is that something that you just picked up along the way as you were growing up? Because? Because it's interesting, right? Because you've gotten diabetes education in America? And and like in a couple of different places. So is this just an amalgam of different ideas? How did you come to this? I can tell you how I came to it. But how did you come to it? I just went to my omnipod.com forward slash juice box. I hadn't been there in a while. And on the pod spruced it up, they put new images there and some new tags, it's a, it's quite fancy. From there, there's nothing to do except fill in your name, your zip code, your email address, and a phone number. Then you tell me about what kind of diabetes you have. And you're off to the races. You get to experience the on the pod for yourself, because they're going to send you an absolutely free, no obligation, experience kit. Like that new word. It's not a demo pod anymore. They're calling it experience kit. Now I like it. It's more, it's more now it's more hip. It's what's happening. It's how the kids are talking. So if you're considering insulin pump therapy, the best way to understand the comfort and convenience the pod offers is to try it firsthand. Get Your FREE experience kit, which includes a sample nonfunctioning pod and see what you think there's absolutely no obligation to buy, you'll be able to wear a nonfunctioning pod to see how it feels. Find the area on your body that works best for you. and experience what freedom feels like when you were an insulin pump that doesn't have any tubing attached. If you'd like to try the insulin pump that Arden's been wearing for over a decade, go to my Omni pod.com forward slash juice box. When you get there, fill in the information, click the big red button that says request your experience kit. And you'll be well on your way, Miami va.com forward slash juice box with the links in your show notes or Juicebox podcast.com. The Omni pod is one of the best decisions we've ever made for our daughter. And I think you'll love it too. This is the perfect way to find out because there's absolutely no obligation or cost. In summary coming. Would you like to swim with an insulin pump that doesn't have tubes.

Isabelle 18:07
We were diagnosed obviously, in New York, and they didn't really I guess, educate us too much at that time. And it was largely down to my mom, basically learning on the fly. So it was a lot of books and that kind of thing. And and I think and I just as time went by I was just curious, and, and looked to different avenues to learn, learn things and. And also just, yeah,

Unknown Speaker 18:45
we did it as it came. Just figure it out as

Scott Benner 18:49
it comes. There's a graph online today and a Facebook page where our parents like, look at this. It's the pump, it's this, it's that I'm like, your kid just doesn't have enough insulin, like I can see, looking at it like you, you can try blaming the pump, if you want, you can try blaming the food, if you can try blaming everything if you want to, you didn't use enough insulin, and now this kid's high, and you keep using not enough insulin to try to bring him or her back down. So you start to get a fall again, then it levels off because you don't have enough insulin. So that weird thought I ended up explaining by saying, Listen, if your blood sugar is too high, you've either you know, you know, you use you've used the wrong amount of insulin or you've mis timed it or sort of a combination of both. And if your blood sugar's too low, you've used the wrong amount of insulin, you've mis timed it or combination those two ideas. That really is it the whole thing is timing and amount, right? It's just exactly right. You call it whatever you want. I don't get I don't give up what you call it, you know, but it's, it's not a thing. It's not a rule. It's not a it's just common

Isabelle 19:55
sense. It's just yeah, that's exactly right.

Scott Benner 19:59
And so when you try teach that to somebody when someone comes into your, your your boathouse, right? Let's assume that's where your business is in a boat house, where you spend half of your day beating away crocodiles, the other half helping people diabetes, when someone comes in and shows you a graph like that, how do you explain it to them,

Isabelle 20:17
depending on the particular person who you're explaining it to? You be they adults or, or child, but also that particular person's personality, which I guess you get, you know, off of, off of how they appear and how they talk to you and what they say to you and everything like that. So it changes for everyone. Sure,

Scott Benner 20:41
no, I hear you because I spoke to somebody This is long enough, long and long ago enough now that I don't feel like I'm hurting anyone's feelings. But I spoke to someone who one time was a younger parent. And I mean really younger, and didn't appear through, like initial contact, that they probably got much past high school and their understanding of things was really more basic, right, like, and I really credit the conversation that I had with that person years ago with the simplify the idea is, because I was

Unknown Speaker 21:13
on the

Scott Benner 21:14
phone with a person I never met before who I sort of had said, I'll do my best to help you. And then once I got into that moment, I was like, I don't want to let them down. But what I'm saying, isn't registering with with her. And so I found like these different ways in that phone conversation. It was the first time I ever said to anybody, Hey, you got to think of it like a tug of war. And now, right? And now I say that here on the podcast, and people like, Oh, that's incredibly helpful, because I've now honed that, that idea by saying it to people over and over again till I've gotten it down to like a, like a brisk, you know, couple of moments to make up. I actually said to somebody the other day, there's a parent, I'm considering talking to you privately. And she said, I don't know how much time I have. I said, Don't worry, I can explain diabetes in between 42 and 55 minutes. And I really feel like that Now, like I can give you I can take somebody from very little understanding to a more firm footing in less than an hour. And and if they can follow along and keep up, you know? Yeah, yeah, it's really it's not as difficult as people make it feel. I guess, I don't

Isabelle 22:27
even know if I feel like I could do that, though. And I don't know, I don't know if that's, maybe that's because I'm, I'm spreading myself over every type of diabetes. But

Scott Benner 22:42
we're also giving complete information. I'm kind of painting. I'm sort of repainting your perspective, when I talk to you. Like, like, do you know what I mean? Yeah, like I'm taking this thing you thought about insulin. And you know, people say I'm afraid and I go, Okay, well, here's why you shouldn't be afraid. And here's where we can take some of the fear away. You just give them a fresh coat of paint on their thoughts. Because I think what happens to most people is just what happened to you, you get this very incomplete, you know, instruction when you're first diagnosed. And then you build off of this incomplete information, which only means you're making, you know, mistakes along the way. You know, you're assuming things you shouldn't assume you're letting your fear get out of you. Before you know it. You're so far away from your diagnosis, and so scared and freaked out and lost. That you know, what you really need is you need a reset, you know, you need somebody to push the buttons. Okay, let's start over. Think about it like this. Yeah, exactly.

Isabelle 23:40
And, and if you don't, if you don't just do that yourself, yeah, exactly. You just need someone to, to say you're, you're allowed you're It's okay. Just Just do it.

Scott Benner 23:50
All the permissions a huge part, which is ridiculous. is silly because I it happens to me all the time where an adult says to me, I don't understand it. Now that you've said it. I don't know why I wasn't doing that. Yeah, and I say this all the time. And I believe it's completely true. Doctors, you know, police officers, teachers, you grow up your whole life, your parents tell you just listen to those people. Don't Don't question them. You know, like, they have your best interest at heart. They know better than you. They went to fancy college, you didn't go to fancy college, or whatever it ends up being. And so we're just we're indoctrinated through you to just listen blindly. And so what I want what I find happens is that by the time people get to me, it's almost like a bad horror movie. Like they realize they should leave the house but they can't bring themselves to do it. Like everyone around them is being killed and they're like, you know, my car's here. I should probably go and instead, what's the chances there's a murder in the house with a knife, I'm probably imagining this whole thing. And they just stay till the bloody end, right. And you just need somebody to say you need to be the real voice in their life who's yelling from the theater, get out of the house. You know, and so yeah, once someone gives you permission, it's funny how interesting, because what am I really saying to you? You should trust yourself more.

Unknown Speaker 25:08
It's a one Exactly.

Unknown Speaker 25:09
I'm saying, you know, yeah,

Unknown Speaker 25:11
do do find

Scott Benner 25:12
that that is true with the people you meet or, or, I mean, sometimes.

Isabelle 25:18
Yeah, definitely sometimes. You know, sometimes it's, it's that and sometimes it's just, it's just that they've gotten random information from random people, and they just, they're trying to follow, follow what they've gotten from everyone. And, and it's all just so obscure, and I'm like, No, just just look at it yourself. Just listen, just, you know, you see it going up and down, you know, you don't need to actually do what this person or that person said, Just do what doing what you do, what you see needs to be done kind of thing. And, you know, listen to, you know, that test that you're doing, or you don't, it doesn't need to be, you know, based on any particular, you know, any type of information or that kind of thing. It's, you know, in the here, and now, what do you need to do

Scott Benner 26:28
is, well, I'm going to tell you that I think that you are, you've completely hit on something that I don't think I've ever articulated. But now seems like such a great time to do it. When you go find other people online, and you don't know them, you're listening to other people who don't know what they're talking about to they were there five minutes before you go, and I don't know what to do. Then someone came around and told them something, which by the way, may or may not have been true, or accurate or helpful. And then five minutes later, you show up and because they're they're already before you you think they know what they're talking about, then they tell this bs thing to you. And now you think it's a rule? And it's Yep. All right. It's It's so community is incredibly important. If it's, if it's if it's good information, but how do you figure out what's good? And what's bad when you don't know what the heck you're doing to begin with? Exactly. And what I mean, like I could put a, I could put a 10 year old in the car and tell them that the brakes the gas, the gas is the brake and pretty much talk them into driving into a wall if I wanted to, you know, every time you think the car when you think the car needs to stop, push the one on the right. Even if it feels like you're speeding up, trust me just keep pushing it down. Because that's what ends up I mean, think about the person earlier with the, you know, the graph and its people. There's something wrong with your infusion set. It might be your insulin, it could be this.

Unknown Speaker 27:52
Yeah, exactly.

Scott Benner 27:54
Did this happen? Has anybody, blah, blah, blah. But there's 19 different things. Now this person went from I don't know what to do Someone, please help me to. Okay, we'll just consider these 19 things and try out which, by the way, as I'm looking at the graph, and I'm looking at what people are saying, it's my I don't know for sure I'm not there. But it's my best. Yeah, I'm like, this is not enough. This is this guy's gonna spend days throwing away infusion sets and to get through a $40 vial of insulin in the garbage. And I'm just like, could you just like double your bazel there for a little bit. And let's try bolusing. Again, I think it's gonna come down in a half an hour.

Unknown Speaker 28:35
You know, like, yeah,

Isabelle 28:36
that's exactly. Yeah, that's exactly what I'm what I'm like, and um, it gets me into trouble sometimes as well because, like, other other health professionals and other specialists really don't really don't like changing things like that. And certainly,

Scott Benner 28:55
morons Isabel, okay.

Unknown Speaker 28:57
They just

Unknown Speaker 29:00
see, you're gonna make me upset. You're having a nice time. And so I

Unknown Speaker 29:04
may upset you. It really annoys me.

Scott Benner 29:07
Why do you think they won't just say to somebody, the first and most obvious thing, which is

Unknown Speaker 29:13
more influential, eat

Scott Benner 29:13
more, and you're not using enough insulin in your time yet completely wrong? Do you think they don't? So this is interesting, because I think you have a better insight in this than I do. Do they not know, where did they not want to be the ones that make your blood sugar low?

Isabelle 29:31
I'm certain that they know they have to know right.

Unknown Speaker 29:36
I think I think I think

Scott Benner 29:37
that's a huge assumption. I really do.

Unknown Speaker 29:41
I know.

Isabelle 29:42
I know. I think I think it I I would think it has to lie in that they don't be want to be the ones that to make your blood sugar low.

Scott Benner 29:54
That's really terrible. It really is to let someone live an entire life with an elevated blood sugar. To give them the stress and the anxiety and the health issues that come with that, and to make them think that that that this is like, quote, just diabetes, and there's nothing you can do about it. So just live this horror, you know, every day and every night forever and ever. And then this person is telling you that 100% knows, either it's not true or knows they don't know what they're talking about. Like, I don't know how with good conscience. Yeah, that's just horrible. You can give bad advice, right? Like, a real person who was concerned for your health would say to you, I have no idea. Go find somebody who does. Yeah,

Unknown Speaker 30:33
exactly. Right, right.

Unknown Speaker 30:34
Yeah, that's right. Not like, hey, let's

Scott Benner 30:36
flip a coin and try this now. Or I like the I like people with a graph, the kids blood sugar's 250, all day long. And they said, Oh, I contacted bar, our endo, and we're moving up our basal rates by 10%.

Unknown Speaker 30:51
Like, I'm like, Oh,

Scott Benner 30:52
well, what will that do? Make the kids blood sugar 230

Unknown Speaker 30:55
all day long. Like, what are you?

Unknown Speaker 30:58
Seeing? Right? Yeah,

Isabelle 31:00
I think sometimes that like the, the ones who are looking after it, you know, they don't, they don't have diabetes, they just don't quite understand.

Scott Benner 31:13
You know what else is often misunderstood? people's desire to not have a ton of carbs in their food. Some people just don't want that. Some people are looking for high protein, no green and low carbs. They want nutritious, and they want tasty. Some people are just like, Oh, just eat stuff with carbs in it. But that might not be for you. And if that's how you want to eat, you're absolutely in luck. Because there's a listener to the Juicebox Podcast, you will save 20% on your order at real good foods calm. Now, real good foods has an incredible selection of foods. I don't know which one you're going to want. You are gonna have to head over to the website and check it out for yourself. But I know there's cauliflower crust pizza, which is like all the rage right now. They also have pizzas with chicken crust, like crust made out of chicken. Gobble, gobble. How about cheese pork or chicken enchiladas. They even have chicken poppers with pepperoni, mozzarella, jalapeno and white cheddar, artichoke and cheese. And if you can't decide which one of those you want, just get a mixed case. For pepperoni. For jalapeno, you can do whatever you want. The cauliflower pizza has come in vegetable pepperoni, Margarita, and cheese. I think what I'm saying here is that you need choice. And real good foods offers that choice. You want to make the choice to eat low carb, do it. You don't want grains and your products, do it. You want to decide between jalapeno and pepperoni poppers mix up a case anyway you want you do it. And you can do all of that while saving 20% on your entire order plus getting free two day shipping. That's just for listening to the Juicebox Podcast. So go to real good foods calm. And don't forget to use juice box at checkout.

Isabelle 33:02
or understand exactly what needs to be changed or by how much or understanding why that is as well. And they just they just kind of go Tinker twinkletoes around it, you know, they just really don't change it by enough to make any significant differences. Obviously, you've noticed

Scott Benner 33:24
Twinkle Toes is a strong candidate for the title of this episode. Just so you know. No, and it's it's absolutely infuriating, because and I've used this stupid analogy before. But if I taught you today how to drive and you'd never driven before. And I told you don't press on the brake too hard, because it'll send the car into a skid or something like that. So just press down halfway. And then you went out and you were driving and I don't know you're driving towards a tree and you press the brake down halfway. But you weren't stopping? Would you just continue on with my advice until you crashed into the

Unknown Speaker 34:00
great? Course not?

Unknown Speaker 34:02
Of course not. Except

Scott Benner 34:02
that's what we all do with with our bodies, right? We're just saying what the guy said to do this, you know? And yeah, it's and how is it not? Listen,

Isabelle 34:13
how does it not change?

Unknown Speaker 34:15
Not change. Right? Right? How

Scott Benner 34:17
doesn't someone now and just like small increments, I have people who go back to their endos all the time. And I love you people who do this. They go back, they have a significant change in their agency, they have a significant change in their stability. The doctor says this is a miracle, which by the way, it's not a miracle. It's just they understand how to use their insulin. Now,

Unknown Speaker 34:36
what happened? And they tell them it took a lot of hard work as well. Yes. And they tell them look, I

Scott Benner 34:41
learned this on a podcast. be silly, you know, disregard me if you want, but I listened to you for years, and this is what we go. And I listened to a random guy on the internet. And this is why Right, right. Yeah. That really is the interesting part. I was trying to explain this to the a DA the other end The other day because I'm really trying to get this message into educators hands.

Unknown Speaker 35:05
But

Scott Benner 35:07
it doesn't really take that long. Like I take. I've seen people most emails most of your correspondence back to me, people who found a clicks for them, usually, yeah indicate 90 days. It took me about three months is what most your email say in a bed. They'll people who really struggle will say it took me two visits to the end. Or and then when you talk to them a little more, you realize they heard you but they got stuck on one thing and they couldn't make the decision. Some people be like, I hear what you're saying. But my agency didn't really go down that much. And then as I prod them a little more, there's Well, I don't Pre-Bolus still, like Well, okay, well, that's why, you know, or I haven't been as bold with my insulin as i as i think i should be. Okay, well, that's why. Yeah, and that's the thing. Yeah. You know, they got to get over but all it

Isabelle 35:55
all it really ever comes down to is more influence. Yeah, it's so stupid. Yes. People are just ever so scared of it.

Scott Benner 36:04
By the way, let's say this. totally reasonable. Right, right. Like it's completely reasonable to be. You know, I mean, you and I are talking in the beginning of October. And just last night, the episode with Izzy me hand went up, and I'm sure you haven't heard it. But

Isabelle 36:22
is he you know, that I've seen your podcast, read your blog, and post. And so

Scott Benner 36:29
it's so amazing, because by now by the time people hear this, they'll have listened to Izzy. And I really want them to revisit this idea for a second, like it's easy to say is he used too much insulin, she passed out she crashed her car. It's a very, it's a very basic look at what happened. What really happened, if you listen to her is that she was normally a very healthy eater who one day just got incredibly hungry at school and decided she was going for it ate a bunch of kind of junky food that she doesn't normally eat.

Unknown Speaker 37:03
Normally, yeah,

Scott Benner 37:04
she didn't know how to Bolus for it. And she didn't Pre-Bolus for it. And so she gave herself some insulin, her blood sugar started shooting up, she waited probably too long to try to address it. Then she addressed it with a bolus. And then it kept going. And she addressed it again. And even as that happened, a number of hours later, she was pretty her blood sugar was good. It was very, it was very stable. And at a good number. The one thing she didn't take into account was that the Miss timing of the insulin like sure what she put in was able to stop this giant spike and bring it back. But she forgot that pretty soon the insulin, the insulin was going to still be active while the food was going out of her system. And then she told me she counted on her CGM to tell her if she was getting low. She made this great analogy made this great analogy. She said, I used to treat my dexcom like a GPS. And I was like, What do you mean, you know, and she said, I follow my GPS wherever I need to go. But the truth is because I do that I don't understand the roads at all. I don't ever know where I'm at. With this thing tells me and she said and I've been doing that with my Dexcom. For years, it's always been okay, but this one time, her blood sugar dropped faster than the technology could could keep up with. And so she did not get an alarm that told her Hey, something's going bad because the thing didn't know it was going bad when it happened. And you can look, you know, and then I asked her afterwards about what do you still think about the technology? He said, it's amazing. I use it all the time. And I still wear it saved my life a bunch of times it just this one time. It didn't. It didn't. It was a confluence of events, right that led to this low blood sugar. But yeah. Some people will listen in here is he took too much insulin and crashed her car. That's not what is he probably took the right amount of insulin and completely miss timed it with the food. Yeah, that's what really probably happened. And you'll never know for sure. But you know, I think her story was incredibly important to share. But at the same time, I was scared.

Unknown Speaker 39:19
Definitely.

Scott Benner 39:20
But then people would get fearful and say, Oh, see. So, you know, this is maybe my way of coming along afterwards and telling people look, you can't be afraid because your story,

Unknown Speaker 39:29
you know? Yeah, that's right.

Isabelle 39:30
Yeah. And yeah, you Yes, you can't be scared because you hear any stories like that. You've just got to keep on going. But it's the same as with anything. It's, you know, I've heard you use car crashes as an analogy for for insulin, numerous times. And that's exactly you know, it's exactly right. You know, you can't, can't be scared of driving because you you've seen a car crash. You still have to go out and do it.

Scott Benner 39:58
life in general is exactly Like that you can't be I mean, I switched recently to the statistic that a couple of times a year, a large chunk of frozen urine falls out of an airliner and like hits a house or something. Yeah, I don't hide in the house because of my fear of frozen and flying out of the sky. It just wouldn't be so. And if we, if we made a list of all the things to be scared of, then and and you actually

Unknown Speaker 40:25
never leave the house?

Scott Benner 40:26
Well, and you heated that list, you would then have a mental illness. But you really would you would you would beat yourself into a spot where you would say, Well, I mean, why am I even alive? If I just sit in this space, like, like, hoping the urine doesn't hit me, and

Isabelle 40:47
I get such funny images in my head.

Scott Benner 40:49
I appreciate that. Because in my mind, it's like a big iceberg. And it's yellow. And and they you know, and and it's coming down, like at this incredible rate, and, and then and then later, you're outside you go,

Unknown Speaker 41:00
do you smell that? What

Scott Benner 41:01
is that? And why is there a hole in the roof, and so, but like, I just the point has to be that you got diabetes, and that sucks. But this is your truth. So move forward with it, and do the best you can with it. And and don't lie. Don't lie to yourself about what the best you can is. I think that's one of the scarier things I see people do is they talk themselves into believing they're doing everything they can.

Unknown Speaker 41:32
Yeah, yep. You know, yeah, that's right. And I don't, I'm sorry,

Isabelle 41:38
some people, some people are, some people can take it on and just, you know,

live with it and do it, do it right, or try to do it right. And I think some people just you have to be in the right frame of mind, or you have to be in the right place to start doing something like that. I just I have so many clients who are have a few clients who, you know, you just work so hard at trying to get them to just do a bolus, just do anything. And, and it just doesn't get through to them yet. These are mostly younger, younger kids. And you just it just does not even read register with them kind of thing or registers on the day. But then, but then the next day, it doesn't find out. It hasn't. Yeah, exactly.

Scott Benner 42:34
I think the other side too, and I do want to kind of like add on to what I said is there are some people have legitimate illnesses like like, you know, anxiety and depression and things that stopped them from doing that. I'm not talking to you, you know, you people have a different hill to climb. I'm talking about everyone else who just, you know, doesn't Pre-Bolus for a meal, eat cereal, blood sugar goes to 400 mega, that's just diabetes, nothing I can do about it, and just moves along their way. Because none of that is Yeah, right. Right. Yeah, none of that is true. I mean, what I tell you exactly what was Arden's blood sugar, 88 and stable. It's 85 and stable now. So I with no heads up with a food I've never seen before. With a food, I don't know how much carbs is and I have no context for what she's about to eat. And I hit this number because I use these kind of five or six basic concepts that we talked about on the podcast all the time.

Unknown Speaker 43:38
And yeah, when they come down,

Scott Benner 43:40
it's what you said in the very beginning, I just sort of stay fluid. You know,

Unknown Speaker 43:44
again,

Scott Benner 43:44
I don't get rigid about it. I don't care so much about the math. I don't care. I mean, here's the deal, right? I look at that hashbrown in my mind. And I imagine that in any normal situation, if I was able to Pre-Bolus for it, it would be two units. Right? But I can't Pre-Bolus for it because she's hit me with this. I'm walking down right now to get food. So at a 140 blood sugar, I'm just like, Okay, well put into units, because she's gonna be eating in five or six minutes, these two units is not scary. It's not even a proper Pre-Bolus. So then I then I add the extra bazel and the extra insulin Why? Because now I'm over bolusing the hashbrown to make up for the lack of Pre-Bolus. Right? If you don't let me Pre-Bolus for the hashbrown maybe I only would have used unit three quarters two units maybe and and what it would have been okay, if I could have created the right kind of downward drag on our blood sugar as the hashbrown was going in. But I couldn't I couldn't so I just over Bolus to make up for the lack of Pre-Bolus. Yeah, people don't, that people generally don't think like that. And it's, you know, it really is. It stems from one of my first like visuals in my mind about diabetes. When I tried to explain to somebody what it was like to use insulin Before I really understood how to use it, I said, I sent somebody one time, it's like there's a big scale like a scale of justice in front of me like with, you know, the big dishes on either side that you can put stuff in, you find level, except those dishes have holes in them. And on one side, I'm dumping in carbs on the other side, I'm dumping in insulin, just trying to keep them level, you know, and it's a little more carbs a little more insulin. And that's how it used to feel, to me used to feel like a panic, like I could never catch up to it. But I realized now that was just the beginning of a thought that now later, kind of homemade in the idea of, you're creating a tug of war that you're hoping neither side wins, and you can't let go. And you can't let one side pull first. And you can't let one side pull harder. And when they're both tired, and they stop, they need to be tired and stop at the same time. You can't, one team can't get tired. And 10 minutes later, the other team get tired because then you're going to end up being over pulled in one direction or the other. And and so how do you do that? Right? You start to figure out how insulin works in your body. But it's not that hard. Like it really isn't like I meet people all the time. Like, I'm like, my blood sugar is always 150 won't go down. And I was like, Alright, well, how much would it go down? If you put in another unit? Oh, I don't know. Like, why? like, Well, I mean, what if I get low? Like the way you're not like, you know, you're not the Serengeti.

Unknown Speaker 46:21
Yeah, like if it's at diagonal down and you're like, Oh, God, I

Scott Benner 46:25
just put this one in, like 20 minutes ago, try to realize all you really done is really well Pre-Bolus for whatever it is, you're about to eat to stop this drop.

Isabelle 46:33
You're not risking lower. Yeah.

Scott Benner 46:36
Do you do that ever? Like do you ever miss get really high? And then crush it to bring it down? realizing that what you are, man? Yeah, what you're mainly doing is Pre-Bolus and for the next food you're gonna eat? Oh, completely.

Isabelle 46:48
Yeah, yep. See? Yep, completely. Actually, I did that just tonight.

Scott Benner 46:54
Yeah, cuz a long day for you, right?

Isabelle 46:58
Yeah, well, I went to sleep and then I've I've set my alarm and go No. Real adult.

Scott Benner 47:03
You're a real adult. I would have stayed up and then

Unknown Speaker 47:07
I'm feeding.

Scott Benner 47:09
Are you? Are you breastfeeding? Yeah. Oh my god. Really? That's terrible.

Unknown Speaker 47:14
Yeah, always nice to get. Yeah, I know.

Unknown Speaker 47:17
So tell me a

Scott Benner 47:18
little bit about that. You've had two babies in a short amount of time. How did you find being pregnant with diabetes?

Isabelle 47:25
Oh, um, I didn't find it too bad. Like I had done my research. You had someone on the podcast that I had already previously. looked at. She did a

Unknown Speaker 47:35
ginger book

Isabelle 47:36
about type one and pregnancy. Yep.

Scott Benner 47:42
Have you listened to the previous episode of the podcast? The one where Jake leech came back from Dexcom to talk about the upgrades to the G six mobile app. How about you can say hey Siri, what's my blood sugar now and it tells you I'm already getting notes from people who are telling me that the Hey Siri functionality is crazy helpful while you're driving? If you haven't heard that episode, head back after this and check it out. But to the rest of you. To those of you who don't have a dexcom yet. I want to speak to you in a very deep and soulful voice. Wouldn't you like to know what direction and speed your blood sugar's moving? Wouldn't you like to be able to see your child's blood sugar while they're off at a friend's house or at school? Wouldn't it be great to see how long it takes insulin to start affecting your blood sugar? Don't you think I should start speaking even deeper go to dexcom.com forward slash juicebox to find out everything about the Dexcom g six continuous glucose monitor my daughter ardens a one C has been between 5.2 and 6.2 for five solid years and you know because you listen to this podcast that I accomplish those numbers largely due to the data and information that I get back from the Dexcom g six continuous glucose monitor. Would you like to make a real change and find comfort tried Dexcom g six today go to dexcom.com Ford slash juice box or use the links in your show notes for Juicebox podcast.com results shared or mine Yours may very deep voice decks calm try it today.

Isabelle 49:30
I had read her book and kind of done my research and I already changed all of my rates and all that by myself anyway so I was kind of set for it. And yeah, it was a pregnancy was pretty pretty crazy. It's crazy how how much more influence the body demands. But But yeah, just kind of went along and I was a bit of a pain and pain in my specialist Robots here because I didn't want to induce the I don't know if it's the same in America, but they, with anyone with type one diabetes or diabetes, they, they want to induce it 37 or 38 weeks,

Unknown Speaker 50:16
you said no to that here.

Isabelle 50:19
But yeah, I said no. And that I wanted to get to 40 weeks, you know, if nothing else was wrong, and nothing else was wrong for either of them, like nerds had, like pressured or their size was pretty normal and all of that sort of stuff. So I was like, well, Nope, I'm gonna just carry on and see how it goes. And so I did that with both of them and got to 39 six with the first and then was induced because they certainly weren't let me go over 40 unfortunately, but then with the second just everything went went into labor naturally and had it all without anything which is cool.

Scott Benner 51:06
Excellent. Good for you. Yeah. I think it's um, so it's interesting because you said you read ginger Vieira's? Buck, right. And, and, and, and the one thing that you thought dimensioned, while you were talking was I make I already make my adjustments to my insulin when I need to. So imagine that a big piece of what ginger was telling you was, you can't wait three months to go back to a doctor to move on. You have to do it yourself. Yeah, it's not just great advice for being pregnant with diabetes. It's

Isabelle 51:33
great advice for anytime,

Scott Benner 51:35
right? Because Because what is the real goal? What are they? What's the a one see they put on you when you're that you say you're gonna get pregnant, your ob says I want your a one c one under six? Is that what they tell you?

Unknown Speaker 51:46
Yes. Okay.

Scott Benner 51:48
And so, I mean, is anyone listening? Who doesn't want their agency under sex? i?

Unknown Speaker 51:54
Right. Well, there are people, but But yeah,

Scott Benner 51:58
you know, it's funny, I was talking to someone the other day. Who said, you know, my one c seven and a half, and I'm happy with it there. But but that person had diabetes for 20 some years. And I didn't argue with him. I mean, it's his life, he can absolutely do whatever he wants with it. But I want what I wanted to say to him was your theory about your agency, is, it's just preconceived from what someone told you 20 years ago, when the CGM you're wearing didn't exist. And the insulin pump you're wearing didn't work nearly as well as the one you're wearing now. And the insulin you're using didn't work nearly as good as the insulin you're using blah, blah, blah. And I'm like, so you're using, you're basically using 1980s diabetes advice with 2018 technology. I mean, like I said, I wish him nothing but luck, but I just think he's stuck in an idea.

Isabelle 52:54
Yeah, yeah, exactly. And you also get those people that say, you know, I'm happy it at 7.5, or wherever it is, because I, I feel really low at six. And you're like, but yeah, that's because you're running a little bit higher, and you're accustomed to it. Yeah, exactly.

Scott Benner 53:10
No, no, I'm sorry. I gotcha.

Isabelle 53:15
No, no, I was finished.

Scott Benner 53:20
You're making me laugh. Okay. So.

Unknown Speaker 53:23
And I think,

Scott Benner 53:24
listen, if you're a person who's like, Look, I'm gonna keep my blood sugar at 140. Because I'm scared to death. And this is good. And I'm not disagreeing with you. I'm certainly not saying that.

Unknown Speaker 53:37
You're saying what I'm saying.

Scott Benner 53:39
Right? Don't tell me that 110 isn't possible, or 90 is not possible as an average blood sugar during the day. Don't tell me that it's impossible. Just tell me it's not something you're interested in doing. That's a different story. And the reason why that distinction is important, is because that when you go out into the world and tell people Oh, it's 140 because I'm scared to be in low. You've now told people

Unknown Speaker 54:03
that that's the rule. Yeah. And it's not the rule. It's the rule for you. It's also that there's something to be scared off, but

Unknown Speaker 54:10
like, you're you're spreading the word that it's scary, right?

Unknown Speaker 54:15
They're gonna kill you eventually. It's

Scott Benner 54:16
it's a matter of Well, yeah. And, and so listen, it could happen to any of us. That's the that's the that's the frozen urine part of diabetes. But that that really is very close to the title of the podcast frozen.

Unknown Speaker 54:35
But that's the

Scott Benner 54:35
that's the part of it. That's the leap you have to make here and listen, some people drive their car over 40 miles an hour because they think it makes it less likely to be in an accident. What I'm going to tell you is it makes you more likely to get rear ended by me because I'm going 70 and Okay, and that's maybe my fault, but I hear that so it's a theory idea but so funny. I this is gonna seem disconnected for a second but I saw a person on social media just this morning. Say that they're blocking people. And it feels so good. And I might the inference was they had heard too many kind of mean nasty things around the judge Kavanaugh, confirmation here in America and they had had enough of it. They didn't say what side they were on, which makes this point even better. I don't I don't know if they thought, you know, this guy's getting railroaded. Oh my god, can you believe what this guy's doing? And we're still like, I don't know what side of it they were on didn't matter, right? What what mattered was, I'm blocking people I don't agree with which there's eight in there one way or the other what the value is, and just showing yourself the things you agree with, right. But another person comes into the thread, and says, I just had to block someone to because of how offensive what they said was, and here's what I thought, I wonder if what that other person said was really offensive or not. Or if it was just offensive

Unknown Speaker 55:56
to them, which doesn't

Scott Benner 55:58
make it which doesn't make it wrong. If it's offensive to you, that's fine. But when you're explaining it to other people, the lack of that word, in your sentence directs people to believe that you're right and someone else was wrong. I don't you're right for you, you might not be right. For me, I might have heard what that person said. But they alluded to and think it's the funniest thing I've ever seen in my life. And or I'm not offended by that at all. I think that's honest, or any number of other things. But we we

Unknown Speaker 56:30
we don't and it's

Scott Benner 56:30
reasonable. We don't think about our own thoughts as wrong. But you only have to examine what you're thinking, because look around your life, unless your life is perfect. You've been wrong, sometimes you've made a decision about something and thought this is going to lead me to this, and it didn't lead you there and there probably was a decision back then that would have gotten you there. So just understand that everything that pops into your pretty little head, or my pretty little head isn't exactly right. It's just something I agree with, based on my knowledge of the world, which is fairly incomplete because I was asleep in high school. So it really you have to see, if you don't see that. Well, I think that's something you should work on personally. But if you don't see that when you're telling other people about diabetes, that, you know, you're 200 blood sugar that you can't affect. You know, when you say that's just diabetes, what you're really saying is, I don't really know the answer to this question. Because, and right, and you could, but what you've done is you've just talked someone else in the believing there's no answer to that's the dangerous part. That's the part that makes me upset and somehow our, you will see that I brought something full circle and not. I'm really a magician. Yo, yo. I'm mostly joking and partly really proud of myself.

Unknown Speaker 57:58
Quite impressive.

Scott Benner 58:01
It's quite impressive is now it's cool. It's quite impressive. I don't know, I'm gonna throw the whole three together into like a hodgepodge of words that don't make sense. Really. I want to ask you, what if you don't mind sharing a couple of things. First of all, do you worry about your children having diabetes one day? Or how do you think about it?

Isabelle 58:25
That's a good question. Um, I, I don't worry about it as such, but I, I wouldn't like if they were to get it

Unknown Speaker 58:38
off, but

Isabelle 58:41
I don't but I don't worry about it. And I don't I don't do trial net or any of those things. Unfortunately. I did do I don't know if you've heard of andaya.

Scott Benner 58:55
But what is it? I know the word?

Isabelle 58:58
Yeah, it's another it's another study of type one diabetes. So it's environmental determinants of type one diabetes. And it's a study that they've been doing here in starting in people that are type one or have type one, I think in the family and two are pregnant. And they start, they start the test in pregnancy and they also get information on your diet and everything like that and do blood tests and stuff. And then once the baby is born, they start a whole bunch of tests on on the baby, as well as the mom as well as the baby's diet and everything pretty much and just trying to

Unknown Speaker 59:44
determine like what if there's any seances? Yeah, exactly.

Isabelle 59:48
So I was I was involved in that initially but in I live in Canberra, in Australia, and it's one of the smaller city centres I guess. And there's all a lot of other areas have like, hospitals that do these tests. But, but camera camera didn't and you you literally got sent out like a package of testing material. And you had to do it on the baby. And I was just like, Yeah, no, it's not gonna happen. I'm a nurse, and I know how to do every single one of these tests. Like I couldn't do it, but I just cannot find time to do it. I'm like, it's not happening. That was just

Unknown Speaker 1:00:37
like, said, you don't

Scott Benner 1:00:38
do trial on that. And you said, it sounded a little like you were like, Oh, I'm sorry. I don't but do you not do it? Because you don't have the time? Because you don't want to know if your kids have the markers or because there's a reason you don't do it. What is it?

Unknown Speaker 1:00:52
Yeah,

Isabelle 1:00:53
I I it's partly because I don't want to know, but then I also do want to know, the reason is flimsy. Yeah, I just, I just went through it.

Scott Benner 1:01:08
And I'll tell you whose answer. I'm from a parent who also has type one. those answers always stuck with me the most. Excuse me. Okay, this is the end. Sorry. Sam fold is an American baseball player. He was on the show a couple years ago. And I imagine I'll have them back pretty soon. But he just I asked him about his kids. And he said, I live a really great life with Type One Diabetes. Like if they get type one, they get it?

Isabelle 1:01:37
Yeah. And that's kind of that's my kind of attitude as well.

Unknown Speaker 1:01:41
I'm like that,

Isabelle 1:01:42
even though I kind of I kind of would like to know, but I really don't want to know, because I don't think I Well, I'm sure it would change. Something I did. Like I would probably try and go low carb or whatever. If If I knew they were at risk, but then I don't. I don't think I want to know because I don't want to change that for them. I don't want to and then you know, if they were to get it, that's fine. We can do with it. But But if we were to change all of that prior to like, what's the point? Because they're gonna get it anyway. Yeah.

Scott Benner 1:02:18
You're, of course gonna want to check out dancing for diabetes.com. But don't forget to also find them on Instagram and Facebook. That's dancing the number for diabetes.com Yeah, my fear we did my son once he didn't have markers. And we didn't keep up with it to be perfectly honest. Because I started thinking, if he did have one of those markers, I'd look at him like a ticking time bomb then, like I was just be looking at him wondering when this thing was going to happen. And I thought that's just not healthy for any of us.

Unknown Speaker 1:02:51
Yeah, and

Scott Benner 1:02:52
I it did slow me down. Like, I have to tell you as crazy as it is like, the boys never shown any indications of type one so far. And as he was leaving for college, you know, I dropped him off and in the middle of that very emotional time. About a day or two before we took him. I pulled him aside and I was like, Look, I don't want you to worry about this. This is nothing to worry about. Don't think twice about this ever. But if you start losing weight or urinating a lot are get really hungry and stop using the bathroom. Yep. Those are signs of type one diabetes, and I need you not to ignore them.

Unknown Speaker 1:03:25
Yeah, by

Scott Benner 1:03:26
the way, that's not going to happen likely. So try not to worry about it because I just thought like, isn't it funny, right? I just thought, well, I interview so many people who hit stressors that change of life situations. And they probably they have the markers already and then the stressors sort of

Isabelle 1:03:45
just been like accelerates because of this.

Scott Benner 1:03:47
Yeah, they always think it's you know, everyone always wants to assign blame to why they have type one diabetes, the science will tell you is gonna whenever it happened, it was going to happen eventually. And maybe you got into a stressful situation that maybe sped it up or you got sick and it's been luck, but it was coming you know and so as I told him that I thought I partly felt badly for putting in his head and I partly thought no wait, you know what, this is no different than saying hey, listen, you got to use a condom. You know? Like Like I

Isabelle 1:04:16
you're completely empowering and with that information like

Unknown Speaker 1:04:19
I thought you're better than them

Scott Benner 1:04:20
yep then a week into school he got sick like he got a terrible head cold started losing weight and I was like Well here it comes self fulfilling prophecy and that's fine find out by the way, but

Isabelle 1:04:32
my point is I get where you're coming from with not wanting to know and i also I agree with I agree with taking time bomb factor like I think if I if I knew God like I occasionally check my my kids blood glucose levels as it is like if I knew oh my gosh, like I'd probably be doing it a lot more regularly.

Scott Benner 1:04:56
bg check mom. I don't have diabetes. Please. Hello, I need a prescription for a dexcom CGM for my kid today. No, but it's coming and I can't you know it's a weird space to be in it really is to any other type one in your family line.

Isabelle 1:05:20
No type one. I've had people with type two diagnosed since I was diagnosed. But then the only other thing is thyroid.

Scott Benner 1:05:29
Other endo stuff. endocrine stuff. That's what usually my write up my my wife's whole bloodline. The female side of my wife's bloodline all has different endocrine issues. Not one of them repeats. Yeah, it's really sad. But but they all have

Unknown Speaker 1:05:45
something. Yeah.

Scott Benner 1:05:47
Gotcha. So it was pretty It was pretty when you were diagnosed. That wasn't something. Anybody

Isabelle 1:05:55
out of the blue? Yeah. I think they said my parents looked a bit into into my family and whatever and said, all your great great grandpa might have had diabetes. I'm like, just that had our

Unknown Speaker 1:06:09
babies here.

Unknown Speaker 1:06:11
Thank you.

Scott Benner 1:06:14
Oh, dude, can we say the baby's name?

Unknown Speaker 1:06:16
A hunter. Yeah,

Scott Benner 1:06:18
Hunter is gonna need to be 100 He lives in Australia.

Unknown Speaker 1:06:23
How old is hunter?

Unknown Speaker 1:06:26
Hunter is three months. Wow, that's

Scott Benner 1:06:29
incredible. You made a person. It's pretty damn impressive. I gotta tell you. Is he is he hungry? Or is this the first breastfeeding on the podcast that's

Unknown Speaker 1:06:38
ever happened? It's quite possibly.

Scott Benner 1:06:42
You know, it's funny now that I said that. I thought How do I know someone else wasn't breastfeeding? Or if I guess I never asked before.

Isabelle 1:06:49
heard something. Other hunters. You've had bronchiolitis lately, and he's got a bit of a cough now so you can hear him a lot.

Unknown Speaker 1:06:58
And the other child, does he have a favorite side? Just one?

Unknown Speaker 1:07:02
No, no, no, neither of our are minded.

Scott Benner 1:07:04
Yeah, they'll go away and they'll go wherever they go. How do you find how long did you breastfeed with your first one?

Unknown Speaker 1:07:10
For 18 months?

Unknown Speaker 1:07:13
You are a trooper isn't? That's well

Scott Benner 1:07:16
done. And this is your intention with hunter as well.

Isabelle 1:07:20
Yeah, yeah. Just until, well, Austin is my first and he kind of I think he felt wings because my breast milk probably changed. flavor. I guess when I was pregnant. Maybe I see. So yeah, he sells kind of winged so I guess. Yeah, I'll do it until until possibly doesn't want

Scott Benner 1:07:43
to have Austin look up at you and go, the quality of your product has dropped. I'm gonna go on to something else now. Did you?

Isabelle 1:07:52
I didn't really care too much. It was it was a slow period. And he just he just kind of like that was that dwindled and thought, like reduced kind of slowly and yeah, I it hasn't really bothered me. I don't know. I don't know the feelings that people. Some people get when they're like, Oh, my God, it was the last breastfeed. I wish I wish I could have I don't know done What? Nothing.

Scott Benner 1:08:20
Just imagine your toddler sitting around with other babies going used to go to this great coffee shop, but they changed the formula. And so I just I stopped while I'm looking for another place now. That's really cool. Oh my gosh, that's incredible. Like, how does breastfeeding change? Does it change? I guess I should ask your your self care that you have.

Isabelle 1:08:46
Not for me Really? Normally I think people's blood sugar's go too low with breastfeeding. But I've noticed that mine has no pattern whatsoever when breastfeeding. So like I can I can go high, I can go lower. I can just stay stable. So it's CGM is my best friend. Basically. lost without it?

Unknown Speaker 1:09:08
Yeah, which one do you use?

Isabelle 1:09:09
I'm I'm on the Medtronic. 640 g with the end link?

Scott Benner 1:09:14
Um, no, you're using the How does that work for you? Is it keeping your blood sugar at that 120 spot pretty regularly or?

Isabelle 1:09:22
Ah, no, no. So that I think that's the 670

Scott Benner 1:09:25
That's it. I'm sorry.

Isabelle 1:09:28
That's 70 now so I can I can set my own targets. So I'm generally around the five. That's my target.

Scott Benner 1:09:38
That's really cool. Well, I know I want to let you go out of respect to what you're doing. And at the same time, I feel like for the podcast I need to keep you on while you're breastfeeding. But I am gonna let you go because it is very late. What time is it is it one in the morning.

Unknown Speaker 1:09:54
Midnight, midnight,

Scott Benner 1:09:55
it's midnight where you're at? you're feeding your child. You've done an over an hour, pilot gasps, which I really appreciate. Did I leave anything? Did we not say anything that you wanted to say? I always like to check with you.

Isabelle 1:10:08
Um, I guess you didn't ask about any complications of which I have none. I just want to

Unknown Speaker 1:10:15
I just wanted to the end doesn't

Isabelle 1:10:18
let people know that it's possible, you know, there you don't have to have had diabetes for what? 24 years and, and have complications.

Scott Benner 1:10:26
No, you're not trying you're trying to tell people look, there's a real there's a real path to you know, and listen, I think you would you would you agree you do you do as best you can you do the right stuff. Yeah, there's some listen you there are people out there who could keep their a one C at five and a half and, and still the location. But you're putting yourself Oh, the baby so cute. Okay, now I you know, I've been a stay at home dad for 18 years. I'm basically a lady is the roll. And so when the baby I tried I couldn't get it was really something. I read all the books. I felt like I was doing it right. But it didn't pan out for me. I've moved on. So that kid, what's that? I'm

Unknown Speaker 1:11:18
sorry. You take the hips as they come?

Scott Benner 1:11:21
Exactly. I'm just rolling with this the same way as everything else. Now unless you can make that baby make one more cute noise. And I don't know how you actually make a baby do that. I'm gonna let you go. So you can see you can do what you need to do.

Unknown Speaker 1:11:32
I don't know, either.

Scott Benner 1:11:35
Thank you so much for doing this. I really appreciate it.

Isabelle 1:11:37
No problem. Thank you. And thanks for the podcast. Like it's awesome. I really try to tell as many people as I can here. I'm telling all my all my certainly type one clients about it and thing. Yeah. Got a lot of great information. And yeah, I think I think everyone has value from it.

Scott Benner 1:11:57
Thank you. I very much appreciate that you do that. I appreciate when everybody does that. But that is that's definitely why it's growing. And I just had to put together my proposals for 2019 sponsorships. As I as I, as I looked at the numbers, I was like, wow, this thing is really growing. And it is it is totally because somebody like us out there telling someone about it. So thank you very much.

Unknown Speaker 1:12:23
How long have you been doing it? Again? Oh, gosh.

Scott Benner 1:12:27
I started in January of 2015. So I'll be starting. I'll be starting my fourth year in a few months.

Unknown Speaker 1:12:32
painting. Yeah,

Scott Benner 1:12:34
yeah, it's gonna have to, it'll have 200 episodes, probably. By the time. Yeah, by the time the fourth year starts.

Unknown Speaker 1:12:41
Oh, yep. Very cool.

Scott Benner 1:12:43
I find it very. I find I find it incredibly fulfilling. So I can't imagine not doing it.

Unknown Speaker 1:12:51
Yeah. That's good. Cool. Well, thank you again,

Unknown Speaker 1:12:55
not a problem. Thank you. Bye. Bye.

Unknown Speaker 1:12:59
Bye.

Scott Benner 1:13:01
Well, I definitely want to start by thanking Isabel for staying up so late to record this episode. I also want to thank Dexcom on the pod dancing for diabetes and real good foods. Don't forget that you can find links to all the sponsors at Juicebox podcast.com. Or in the links that are right there in your podcast player, their show notes in there just tap, they'll say it's a pretty long episode. But before I let you go, I want to remind you to leave ratings and reviews in iTunes because they help the show be found. And if you need proof that that's true. Here it is. You guys have been leaving a lot of really great ratings and reviews lately, which I appreciate. Because of that the podcast is steadily in the top 200 and it's category has been for like six weeks. We used to pop in and out of the top 200 but now we're just there were like there to stay. So that's all you guys thank you very very much when you leave those ratings and those reviews that helps iTunes understand that people like the show. It also helps them find the show when they find the show subscribe when they subscribe, we end up in the top 200 Not only that, but we're the best and most well reviewed diabetes podcast online. And for that a sincere thanks. Don't forget to check out the diabetes pro tip series if you haven't seen those, and I'll be back next week.


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#213 NEW Dexcom G6 Mobile App (Now With Siri)

Scott Benner

Jake is back from Dexcom to review the all new G6 mobile app.….

Jake from Dexcom is here to review the all NEW G6 mobile app. That's right, version 1.4.0 is available now and it features Siri, MORE followers and a lot more!

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon AlexaGoogle Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT


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
This episode of The Juicebox Podcast is sponsored today by Dexcom and Omni pod, you can go to my Omni pod.com forward slash juice box right now to get a free no obligation demo pod sent directly to your door and go to dexcom.com Ford slash juice box to get started today on the dexcom g six continuous glucose monitor. If you can't remember those links, don't worry, you can find them at Juicebox podcast.com or right there in your podcast player showed us.

Hello and welcome to Episode 213 of the Juicebox Podcast. I did not expect to be bringing you this episode today. But when Dexcom called last night to tell me the new g six mobile app was going to be released in a couple of hours. I thought I need to get Jake leech on from Dexcom. So we can go over the upgrade and see what's there. Not only are we going to be talking about the additions to the G six mobile app, we're going to talk about the timelines for the Dexcom g seven year me right health Canada's approval for G six, and a couple other little tidbits that Jake is thrown in. When you're done here today, you'll understand everything that's coming in the new upgrade. You'll know when your Android app is going to be available. And you're going to be practicing your Hey Siri. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise in the Always consult a physician before becoming bold with insulin or making any changes

Unknown Speaker 1:36
to your health care plan. Scott, Jake, how are you sir? I'm great. How are you?

Scott Benner 1:47
I'm excited about the new GCC mobile. That's how you know you're short on time. So I'll jump right in RNN. I downloaded the update last night which is 1.4 point. Oh, is that right?

Jake Leach 2:00
That's right, one, version 1.4 point zero.

Scott Benner 2:04
And that's the G six mobile app have any other apps? Were any other apps updated last night or are going to be soon?

Jake Leach 2:12
Yeah, the so that was the G six app for iOS. And that was updated when live in the store yesterday, February 27. And we have the updates through the G six Android app that we'll also be getting the Play Store very soon. It's targeted to be right around the same time as the iOS, the iOS when first Android will be very soon.

Scott Benner 2:39
So so even today being February 28. I think just days from now, you shouldn't get should be up in the Google Play Store.

Jake Leach 2:46
Yeah, it probably won't be up. You know, today, but it will be in the real near distant future. We're just we're just basically doing a couple final tests on it. But it has the same features, General features as the 1.4. It obviously, Android doesn't have the unique Siri feature that comes with iOS. But it does have the some of the other features, as well as a new feature where we're sharing data with Google Fit on the Android platform, so that other apps similar to the way health kit works on iOS. On the Android version, we'll have the fit database. If the user selects, they compare their retrospective CGM readings with another app on the phone. So encouraging developers to develop apps that consume the dexcom CGM data and give users a even better experience.

Scott Benner 3:42
I always love that thinking. And there's a I'm seeing in the notes here a three hour delay for the information to go from the Dexcom into the Google Fit. That's pretty standard, though. Does the Health app have the same delay? On the apple side?

Jake Leach 3:52
Exactly. Right. Yeah, it's it's retrospective information. So it's three hours delayed. That was the kind of agreement we got to the FDA A number of years ago on the two different classifications. The idea is that the rest of retrospective data can be used for a therapy decision making in real time like, such as how much insulin to take. So it has a lower level of regulatory oversight. And so the FDA was kind of comfortable with us putting that data in healthcare where basically any app that the user selects, they have to authorize it, but they can authorize any assets able to consume that data to consume it and do offer a, you know, a unique experience around.

Scott Benner 4:32
So we're hoping developers jump in and try to take advantage of that.

Jake Leach 4:37
Yeah, yeah, we've had health kits been enabled on my iPhone for quite a while through the G six, and even the G five apps. And on the Android platform, we have S Health, which is a developed by Samsung, but is available on all Android devices. We've been using that database and now we're adding the Google Fit database as another option.

Scott Benner 5:00
Okay. All right, so I'm seeing a handful of new features in the app, I'm going to start with what I'm going to consider to be the slightly less exciting ones first. But I do want to address so you can submit a technical support inquiry through the through the mobile app. I mean, what, what's an example of something I might want to submit through that.

Jake Leach 5:22
So the technical support, send technical support feature has been in the app for a while, the unique thing about the new feature is that it puts you into a browser, which allows you to select the, you know, the issue that that you're experiencing. So for example, if you're having signal loss issue with the connectivity, you know, some some users do run into that. And our technical support has quite a few things that they can work with the user to resolve that issue. And so that would be a nice example, you can select that and then send it in tech support. And so it's easier for the user to describe in terms that our tech support will understand quickly. That's kind of basically it's about facilitating the the technical support conversation with this sense of technical support.

Scott Benner 6:15
How does the back and forth happen, then do I receive an email back for you? Does that happen within the app,

Jake Leach 6:21
but it can it's generally a phone call will result after you send it in. Sometimes we do over email as well. But the real idea is, Hey, I'm having an issue, I need some help. And to help facilitate that, make it easier.

Scott Benner 6:37
Great. Okay. And then you don't have to go to a Facebook page and wait for someone like me to come in and explain it the 9000 time I've said it, and it starts coming out my typing where I'm dropping words. And I just, I want I once just said to somebody just cycle the Bluetooth, then that launched me into a problem where I had to explain what I meant by cycling the Bluetooth, which then made me think, Jake, why did I do this? I should actually just minding my own business. Okay, so now within the app, there's a button to launch clarity. So there's still two separate apps, though, correct. But I can like I can be in my mobile app. And then is it only on the 24 hour view? that that that link is there or is it somewhere else that I'm not seeing it?

Jake Leach 7:24
It's, it's in two places. So you're right in the in the landscape mode, when you turn the phone sideways and shifts, it shows you the more detailed information in the 24 hour view. In the top right corner, there's a little icon that has the clarity link icon to click on that. And it launches you automatically into the clarity app. If clarity is not installed on the user's phone, it'll redirect them to the store either the App Store for iOS or the Play Store for Google and prompt them to download that clarity yet, so it isn't on landscape screen. It's also in the event screen. So when you go to enter events down, down below on the menu in there, there's also the clarity Link button in there.

Scott Benner 8:13
I'm going to just say that I absolutely I adore the clarity app. And there are days and weeks and months where I think that my daughter doesn't even need to go to an endocrinologist anymore because I have that app which is obviously a stretch but it has so much information it really makes me feel like I know what's going on kind of behind the scenes with her blood sugar's you know that that's how when the when the nurse walks in the room and says, Oh, we know what tre one says, I'm always I'm always like, Oh, I know what our average blood sugar is. I figured that out. Is it this? And I guess and it's incredibly accurate for art. And so it's a great app. If you don't have it. Absolutely. Check it out. Now, you'll be able to bounce back and forth between your mobile app and clarity app with a touch of a button, which is excellent. Apple Watch Series four face complications. Did you add to or are there more and I'm not seeing them?

Jake Leach 9:02
So the with the new series four has the more round complication features. Yep. So in a different series for watch faces, they have places for you to add your complication. So we've added the the round one that's compatible with that watch. So that's a that's a unique one. That's only four series for that we had that that level of compatibility, it shows the arrow and the number. And there are a number on on the watch face. Oh, nice, nice feature kind of, we expect to bring more. That was our first one. We're starting with the simple round complication. But we we have others that are now capable on that platform. we're experimenting with a trend graph. complication that's

Scott Benner 9:49
a rectangular kind of complication. Now you can add so we're working on those but in this release, we've introduced the first one which is the round one and this is liveview. It's my blood sugar number. Right, they're not just touching it to open up the Dexcom app.

Jake Leach 10:03
Correct? Yeah, true, it's realized value.

Scott Benner 10:06
Is that for just the where, like for the person with diabetes wearing the transmitter? Or can that be for a follow watch as well?

Jake Leach 10:15
If not yet, we are in the midst of doing a refresh of the follow app. But a few updates to the follow app. But as the right now for this release, it's the features for the user of the CGM, the personal device, okay.

Scott Benner 10:33
I won't hold you to I'm not gonna ask you how long till I get a new follow up. But just coffee if it's in like the next few months, or something like that.

Jake Leach 10:40
It will be. There'll be a steady stream of updates, but there will be one coming soon.

Scott Benner 10:46
2019 the year of the app, I love it. exploration. So now Now I can get a 24 hour sensor exploration reminder. It'll happen automatically. Is it user definable? Can I shut it off? Or is it always on?

Jake Leach 11:03
Great question, Scott. So it's a, this was feedback from our users about the having the 10 day sensor, they wanted a reminder at, you know, 24 hours in advance of when that sensor is going to expire so that they're sure to be ready to switch the sensor out when it does expire. And so it's, it works just like the six hour and three hour warning, but it just happens at 24 hours. And if the user doesn't have to do anything, it's just automatic.

Scott Benner 11:34
Is that going to exist on the follow up when it comes out?

Jake Leach 11:37
Are you able to say because here's what that is a great that features in our in our backlog of items to implement is not going to be in the near future. But that's definitely one of the features that we want to put in there. It's a great use case where a parent wants to know a when does that sensor need to be replaced? And you'll be able to see it from within the follow up not just on the user's app. Yep, that's a great, great idea.

Scott Benner 12:03
I see two things happen with us, first of all, are no get the like the two hour or the six hour reminder that existed prior to this one. And she clears it out so quickly. She doesn't even know what it said. So I was gonna suggest if maybe a cartoon hammer could come out of the phone and just like donker on the head and yell, tell your dad this. That would be really helpful, because then later, I'm like, hey, the CGM says it's expiring and I didn't warn you. And she goes, Oh, is that what that was? And I was like, yeah, that must have been. But yeah, anything, maybe even just somebody could grab her and say, now would be a good time to stop focus for a second and remind someone that you've gotten this alarm. But yeah, all that kind of stuff on the follow would be fantastic. Okay, so you guys have expanded share functionality in regards to how many followers we can have, how many Can I have now used to be five. I just had a very interesting experience. Last weekend, I was somewhere speaking. And outside of the conference room, I spoken, there were vendors and they all had insulin pumps, and glucose monitors and stuff like that. Now, this event had a lot of newly diagnosed or newer diagnosed, people living with type one diabetes, and I watched a number of them hold up these insulin pumps from other companies at the table with all this tubing on it. And you could see on their face, they were like, what am I gonna do this. But when those same people made it over to the Omni pod table, and they just held this tiny little pump in their hand. And that was it, it was all self contained this little pod. When the people behind the table explained to them that you know, you don't have any tubing with it on the pod, you just wear it on your body. And that's it. There's this handheld controller that you know, you tell it how much insulin you want, set a Temp Basal rate, maybe or start a bolus. When they realized that that controller wasn't attached to the pump that they weren't going to have to wear tubing hidden in their clothing. Just this beautiful feeling of comfort came over their face. They were smiling at the other tables grimaces and What is this thing? But at the Omni pod table, everything seemed hopeful and happy. I am not making this up. This is my honest to god evaluation of what I was seeing happening in the room. And those people all left with what you know, a free no obligation demo of the Omni pod. They had them right there. They took them home now, I don't have one to hand you but if you go to Miami pod.com Ford slash juice box, you can have a free no obligation demo pod sent to you right now. If you're considering insulin pump therapy or switching pumps, the best way to understand the comfort and convenience of Omni pod is to try a free no obligation demo today. My Omni pod.com forward slash juice box with links in your show notes or Juicebox podcast.com. How many can I have now? It used to be five?

Jake Leach 14:45
Yeah, so we've expanded it up to 10. This one again was based on customer feedback, where you know you've got pediatric patients in particular who have a pretty heavy you know, family and diabetes support network. Quite a few individuals, often more than just five. And so we've expanded it up to 10 followers. And so it works in the same way as the previous version did where you can invite your followers through your G six app, but just now you're allowed to invite up to 10.

Scott Benner 15:18
Alright, well, that's gonna be great for I know, people who actually, like have to, like, drop their school nurse every weekend, and then re add them. And it's so that's spectacular. I know, they're going to be grateful for that for sure. Okay, now, what I consider to be the big one, I'm jacked up about this, I think it's great. I can now ask Siri what my blood sugar is. And Siri tells me and not only tells me, but it shows up on the lockscreen. So first, tell me like what made you? What made you work on this? Was this something people asked for? Is this something you were considering on your own?

Jake Leach 15:53
A little bit of both. It's something that we, you know, it's basically a hands free feature. And so it makes it if you're in a situation where you really driving a car or something and you don't maybe don't have an Apple Watch, this is easy to glance at. So you, instead of having to pick your phone up, you can just ask Siri, what your glucose is. The key enabling technology, though, was with iOS 12. Apple opened up the Siri shortcut, which allows us to develop as an app developer allows us to make a shortcut within our app that uses the Siri library. And so and so this feature has to be set up, it doesn't come automatic because you have to record yourself saying Siri, what's my glucose, and each person has to do that on their own phone. And then you can set it to be able to operate when the screen is locked. And you don't have to write so you can if you don't want it to Siri to be activated for this feature when the phone is locked. And you can select that. But most people want to be able to with their own voice ask Siri, what their glucose is without unlocking their phone. So great use case for driving or when you just can't pick up that phone, but you got to know. And when Siri, when you do ask for what's my glucose. Siri will repeat the glucose value. And the trend arrow lets you know if it's going up or down. As well as things like urgent low alert, it'll explain going low will be able to go back to be 55 within 20 minutes. So there's quite a bit of information that she'll she'll repeat to you, which is important to have.

Scott Benner 17:30
And I actually we set it up last night. So somebody from Dexcom was nice enough to let me know what you and I be talking today. And so I knew when it was I knew it was coming out in the App Store probably before the general public and we got it very quickly. So you have to once you update the app, you have to go into the settings and turn on the the Hey Siri functionality. And then what Jake's saying is 100%, right, you have to record yourself saying it. But the great thing is is you don't have to say hey Siri, what's my glucose? You can say anything. So if you don't want the people around you to know what's going on. You could quite easily say hey, Siri, wire porcupines purple, and then it'll pop up and tell you what your blood sugar is. You know, so you're right, you can say absolutely anything you want there. If you want to be private about it. Arden set hers up where she just said BG please. And and now when she says hey

Unknown Speaker 18:23
Siri, BG please.

Scott Benner 18:26
76 and steady. pops right up on the lock screen, you get a nice set of three hour view that you get there along with the arrow and the number of the graduate. Yes, it's really it's really well done. Congratulations. Very nice. Do you really not have a dexcom? g six yet? Come on people? What am I gonna do here? You need to go to dexcom.com Ford slash juice box right now we hear Jake talking about the dexcom.

Unknown Speaker 18:55
It's insane.

Scott Benner 18:57
Every week on this show, you hear me talk about the strides we make with my daughter's health because of the data coming back from the dexcom g six continuous glucose monitor. Have you not at least gone to the link and look@dexcom.com forward slash juice box? That's where you're going to go to get started. Get started with what you ask? How about sharing blood sugars? How about asking Siri what your blood sugar is? What about seeing the direction where the speed that your blood sugar is going at? How would you like to know if you're 75 and stable versus 75 and falling? Big difference right? You've probably always wondered how long do I need to put my Pre-Bolus and you know, you can find out by putting insulin in and watching to see when the fall starts. You know how you could figure that out without testing eight zillion times with the Dexcom. I mean, I think this is obvious what I'm saying here you got to go to dexcom.com forward slash juice box you have to click on the links in your show notes or Juicebox podcast.com and get started today. I really can Not stress enough how important this is. Results are ours and yours may differ. But I mean, come on, you're never going to know unless you try. Buy a Dexcom get a Dexcom, you should buy Dexcom dexcom.com forward slash juice.

Unknown Speaker 20:18
But in business.

Scott Benner 20:29
Okay, Jake, I rushed a little bit so I could throw in some extra questions, which I'm assuming you were expecting. You went over follow apps? And the updates of that. Oh my god, you should see my Siri is like everything I've said to you for the last minute and a half at ditch trying to answer so far. You heard her name? Yeah. And just and just started recording the podcast. So follow up updates coming, you know, this year. I wanted to ask you just very quickly, g seven. I always feel weird asking about what's next one, what's new is so new. But is there timeline for G seven?

Jake Leach 21:08
Yeah, yeah, we are working hard to, we intend to do what we call a limited launch where we launch it into a market, you know, that smaller, smaller volumes so that we can make sure everything's working the way we want it to. We've got everything handled, we did that with G six. And we'll be doing that with our D seven product as well. That'll be around the end of 2020. So the end of next year. And then the real broad launch will be in 2021 is our plan. And before everything is on track for that. So b seven is a is a new wearable. And it's all in one. So there's, it's a completely disposable device. So there's no longer a 90 day transmitter to keep track of each sensor is combined along with the electronics, the transmitter, the radio, everything you need for Bluetooth. And it's all in one piece, and deployed very simply on the body with a very simple applicator and has the same functionality that we're expecting, you know that your customers are used to which e6 the back of calibration, the performance to be able to make diabetes treatment decisions, all of those things are part of G seven. And then we also intend to extend the sensor duration which is seven beyond the 10 days of G six. So you're getting great performance in a much smaller wearable, the wearable for B seven is substantially smaller than g six in all dimensions. But in particularly in the hype. It's a very low profile to the body, the still still a lot of work to do on it. We still have our big clinical trials that will be running early next year for the device approval. But yeah, we've got a large, large focus quite a few folks working on that program right now.

Scott Benner 22:59
I have to say, I think this is the first time I've ever heard you guys like give like a reasonably solid date two years out before. So things must be a be going along the way you expect, which is very exciting. So basically about two years from now by around the beginning of 2021. If everything goes right g7 should be in a wide release. said about right jacket that right

Jake Leach 23:20
there. That's their plan. That's so cool.

Scott Benner 23:22
Hey, everyone needs a plan. Hey, oh, Health Canada has g six now. Is that correct? You can get it in Canada.

Jake Leach 23:28
Did that just happen? It's approved? Yep. Yep, it's approved. And I think it just it just happened. And so they're we're working through launch timing and availability of the product. But yeah, help candidates approve it, which is exciting. because our goal is to transition as many folks as we can as fast as possible from G five to G six g six platform.

Scott Benner 23:51
So Canadians should very politely start bugging their healthcare providers know.

Jake Leach 23:55
Exactly.

Scott Benner 23:57
Is there is there I don't know you might not be the right person because I know your your research and development is your forte, but how are you guys handling? product need? You're obviously growing and getting bigger and the company shifting. And there was a time where there was a you know, if you ordered a you know, they were like, well, we don't have enough supplies, but that seems to have gone away. Now. How did you handle that? Did you open up more manufacturing? Or do you do someone else manufacturer for you? Did you just have to ramp them up? Is it a case of having to tell an outside company? Look we need more of these than we planned on or how does that work? And why is it working now and how are you going to keep it moving for the future?

Jake Leach 24:42
It's a great question, Scott. It is a little bit of all those things. So the supply chain are the folks that we procure the materials for G six from there's some actually build what we call sub assemblies, so they put together certain pieces for example, There's one supplier that makes the plastic parts for the applicator and assembles the needles into them. And they we purchased that the custom design effects come designed with manufactured by what we call a contract manufacturer. So it's fire. So they make those parts. And then we bring them in and we make the sensors in house in our index comm facilities either in San Diego or in Mesa, Arizona, are two locations where we manufacture sensors, and we bring the applicators in, and then we basically assemble it and put it into the packaging, all those things. So in the situation we ran into was the demand for GS six was substantially higher than we had forecasted, which is a you know, it's a good problem for a company have, but it's not great for our users. And so we really worked hard to ensure that we could build a more capacity for G six. So really, that's what patients have seen. And the reason it's more available is because we've added more capacity, and we were adding significantly more capacity this year than we had originally planned. Because the demand for G six is so great. So we're gonna keep doing it. It's scaling both our manufacturers, or suppliers as well as their own operations. So yeah, it's a tremendous amount of work. Kind of, I call it below the waterline right now that customers don't see it. But we're doing everything we can to make sure we can build enough supply everybody with sensors. Well,

Scott Benner 26:28
I really appreciate it. I will tell you that. This this, this I'm gonna try to use English this last quarter of Arden's life with diabetes may have been the most challenging in in regards to her insulin needs and volatility of her blood sugar, and do in, in large part to the information we get back from her g six. I'm forecasting her a one C to be 5.8 when she goes in a couple of weeks, so I just I don't I can't even imagine where it would be without this technology. It simply wouldn't be possible. I can't imagine how to do it. Otherwise.

Jake Leach 27:07
That's incredibly that's good. It's great news.

Scott Benner 27:09
Yeah. Now I just I couldn't I couldn't thank everyone enough. I was actually out in Phoenix. So a couple days ago, I wish I would have realized you were so close by I could have I could have wandered over and said thank you partner person to a bunch of people who would be like, I don't know who you are. Please get out of here. Jake, I appreciate coming on. I'm gonna let you go early, which I don't think I've ever done before. And the next time you have something you want to share, please let me know. I love it when you come on.

Jake Leach 27:35
Great. Great. Appreciate the time, Scott. And I look forward to doing it in the near future.

Scott Benner 27:41
Take care. Have a good day. Thanks, guys. I don't want to ruin the surprise. But guess who's already booked Jake, back on the show. Again, things are happening at Dexcom. Anyway, thank you very much to our sponsors, Omni pod and Dexcom. You go to my omnipod.com forward slash juice box to try a free no obligation demo pause today. And of course go to dexcom.com forward slash juice box to get started on the Dexcom g six continuous glucose monitor. And you know what? They weren't even part of this episode. But why not go to real good foods calm and save 20% on your complete order by using the offer code juicebox at checkout. And do not forget to go to dancing for diabetes.com. That's dancing the number four diabetes.com. Appreciate Jay coming on at such short notice to talk about the app upgrade. I hope you liked this little bonus episode at the end of the week. So much easier than reading about what's on the app. Jake, and I'll talk to you while you're driving home. Ease of use, not just the Omnipod and Dexcom but the Juicebox Podcast

Unknown Speaker 28:51
76 and steady.

Scott Benner 28:54
Please don't forget if you're enjoying the Juicebox Podcast, share it with a friend let somebody else know say hey, this is how you get a podcast. Let me show you right here. Let me give you a link. Let me tell you the name of it. Let me walk you through it because not everybody understands how to get podcasts. Also, if you're enjoying the show, please leave a rating and review at iTunes. We just hit 300 ratings. Yay. Absolutely stunning. I cannot somedays believe it. I know a lot of episodes went up this week. So just let me remind you that just a few days ago, the first three episodes of my series with Jenny Smith CDE called diabetes pro tips went live if you haven't heard them go back. The first one's called newly diagnosed or starting over. The second one is called all about MDI. But trust me there's more in there than just MDI. And the third is called diabetes pro tip all about insulin. There's more coming next month and the month after with Jenny. And when we're done, we're gonna have a nice series that walks you through the ideas that we talked about on the podcast. deep dives into diabetes management


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#212 Diabetes Pro Tip: All About Insulin

Scott Benner

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

I am thrilled to welcome Jenny Smith, CDE back to the show. Jenny will be joining us for an extended series of conversations that focus solely on the management ideas that we discuss on the podcast.

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon AlexaGoogle Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT


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 0:09
Hello, welcome to the Juicebox Podcast. I'm your host, Scott Benner. This episode is the third in a series with CD Jenny Smith. If you haven't heard the first two, go back and find them. The first one is called diabetes pro tip newly diagnosed or starting over. The second is diabetes pro tip all about MDI. And this one, of course, diabetes, pro tip all about insulin. They're designed to be listened to in order. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan for becoming bold with insulin.

What is it about insulin that people need to understand at its core? And I'll start by telling you that it just a very simple story that that I was in my nurse practitioners office one day, you know, I like to say we're at the end. No, but honestly, I never see the end. Oh,

Jennifer Smith, CDE 1:13
right. It's always a nurse practitioner who is? Yeah, yeah. And most often they've got more time anyway. So that's a good gap. When people

Scott Benner 1:22
say who's your I know, I sometimes have to pause. I'm like, Huh, right.

Jennifer Smith, CDE 1:25
I don't really know.

Scott Benner 1:28
So this was a number of years ago back before I think I would quote unquote, say that I started to understand. And I would say that I've understood diabetes on a different plane for about the last five years or so. Okay, but the run up to understanding it was reaching out into the world and picking these little ideas and really wrapping my mind around them. And as much as I tried to understand bolusing, or understand, you know, the, the peaks and the valleys my daughter was seeing and all the problems we were having. It wasn't until the certified diabetes educator and my daughter's practice, answered a really simple question for me. I asked her if you had a magic wand, and you could change the way people do one thing around diabetes, but would it be and without hesitation, she said, I teach them not to be afraid of insulin. She said that would be the core step one. Nothing else matters if you're afraid of the insulin. And I took that to heart. So I guess let's start with why are people afraid of insulin? What do you think it is? I think

Jennifer Smith, CDE 2:40
the main reason is because the initial education includes so much about hypoglycemia. Insulin, I mean, insulin is one of the very, very few medications on the market, that doesn't have a tremendous amount, but really doesn't have any effect on anything else, you know, it's not going to cause your eyeballs to turn green or you know, your toenails to grow extra inches or anything funny, right? It's its side effect, let's call it is hypoglycemia, low blood sugar, if you don't understand how to use insulin, right, so that I mean, it's drilled into you, if you be careful of low blood sugar. This is how to treat low blood sugar. These are symptoms of low blood sugar, I mean, low blood sugar, low blood sugar, low blood sugar is drilled in. And so what are you going to get from that? I mean, if you're told every time you come to the stop sign that some car is gonna come and swipe you. You're not gonna like go into a stop sign either, are you?

Scott Benner 3:45
It's funny, I think of when you say that I thought of driving in my mind right away a little differently. I thought of when you first teach someone to drive, you teach them about the brakes. Right? Right. Right. So it's the it's the first thing you think, right? Like, even if they steer wrong, or anything, they're doing wrong, if they can stop, maybe they won't get hurt too badly. Right. And so it is really the same idea. I guess for doctors, they look at the giant picture that is type one diabetes. And they say what's, what's the thing where these people could run into a wall, they could use their insulin incorrectly cause a scary low a scary low might mean if you're an adult, loss of your own function, inability to stop that fall from continuing. Right, right. And then so let's talk about granularity for a second because I don't think we do this enough about diabetes. Insulin extracts sugar from your blood. Is that right? Yeah, yeah. And unlike my body, which knock on wood has a pancreas, it's working it my body knows when to stop. It gets me to a nice level, and it stops. manmade insulin is going to work until it's not there anymore, and work

Jennifer Smith, CDE 4:54
and work and work and work and it's going to work in an interaction setting with The food that it's meant to work with or the glucose that's in the in the bloodstream for it to work with now, there's too much insulin there, and there's not enough glucose for it to continue to work with. And it's still gotten a whole hour of action. Absolutely low blood sugar.

Scott Benner 5:14
Yeah, it's not going to cause a low blood sugar. Like you said, if there's impact of carbs impact of body function, then that's what the insulin is working against a minute, the carbs are going from your system or the adrenaline you had is gone. This insulin, if it is still there, if you've missed timed, it, is going to continue to work. So that we know what we are scared about. Let's be more more honest about it. I'm gonna test myself and you'll tell me if I'm wrong. Sugar is the energy that our brain works off of. It's the the gas for our brain, right?

Jennifer Smith, CDE 5:51
It is. Yeah.

Scott Benner 5:52
And if there's not enough sugar in our blood, our brain shuts off like a light switch. Is that correct?

Jennifer Smith, CDE 5:59
in an easy way of saying it? Yes. If our brain is not getting the that sugar? Yes, we that's why all of those strange symptoms come about with low blood sugar, your brain is being deprived of the food it needs to function to think the right way. Yes.

Scott Benner 6:19
Let's just throw it on the table, what everyone's really afraid of right. Nobody wants to die when they're sleeping. That's what everybody's concerned about. I don't want to say that that's not an issue, because if it happens to one person, it's an issue. I would say that I do think of it again, like driving like I, I think driving is incredibly dangerous. But I do it every day. If I happen to have an accident one day where I'm killed, I will not be thrilled about that, as I see the telephone pole coming for me, right. But I think that's maybe the cost of doing business for being alive, I have to get around, I have to travel. Right? I think the same thing about diabetes, you need to use the insulin in an effective way to make your life healthy, longer, happier, you know, all that stuff. So you have to learn how to do this. And then the rest of it just like driving, you throw it away, you're like, Okay, I'm going out there, and I'm going to do my best. And the first thing that happens is people get dizzy, confused, they're easily agitated. But then as your blood sugar continues to drop, you lose the ability to what, like what happens as you continue to get lower.

Jennifer Smith, CDE 7:21
And again, this is where symptoms are different for everybody. But truly what can what really continues to happen is the loss of the right way of thinking you it just continues to decline. And if it gets far enough, you could lose consciousness, you know, you could certainly no longer be awake, doesn't mean doesn't mean daft, but it does mean that you could certainly pass out, um, from a low blood sugar. Yeah, you'll

Scott Benner 7:51
hear it adults sometimes say they knew it was coming, they consumed a ton of food, then wake up on the floor, because then the food gets in and it turns things around for them. Wow. So I'm gonna I've said this before, but, you know, for context in this episode. Prior to technology, I mean, honestly, back when we were needles and little tiny like I've said before, like a diabetes bubble gum water, right. I have caused Arden to have two seizures. One right after she was diagnosed, she was only maybe a few months into it. And I had this grand idea that I had figured the whole thing out, which probably meant she was honeymooning. Right, right. And we go to the mall one day to pick up some stuff real quickly. My wife's going on a trip and we need I think another bag or something. Everybody gets hungry while we're running through the mall. And here's this like, mall Chinese food. And I thought this does no big deal, right? I'll just count the carbs and I'll shoot the insulin and she'll eat the food and she ate and it was good. And she was little two years old. She ate a little bit of food. I gave her No, not a lot of insulin for a 20 pound person. Right, bought the bag went home. She fell asleep in the car later in her crib. My wife and I are helping her. I'm getting her packed up for what she's doing. And then I hear what sounds like a wild animal in my house. grunting and snorting and like like that. And I go into the room and there's my daughter. She is having a seizure in her crib. And so I pick her up and I don't know what to do. I mean, I know the doctor told us about glucagon. But for the life of me in that moment, I couldn't. I couldn't hold my hand. Still, I couldn't reconstitute it. It was a disaster. While she's on the floor, and my then seven year old son is dialing 911 for us My wife is rubbing glucose gel in her cheeks. And as I'm fumbling with the glucagon and really messing it up, Arden is blind. If you touch her she overreacts in a way like she thinks she's being shot like right like he or she is grunting and incoherent and then it just ended. Like when the glucose gel was And she came back and the police came into the house and the rescue squad and we went to the hospital and now I look back, we didn't even have to go to the hospital. Like the hospital was nothing. By the time we got there, her blood sugar was back up, and she was fine in this whole thing.

Jennifer Smith, CDE 10:14
But it's scary. I mean, just, you know, you're saying it. Yeah. You know, I mean, and I talk with and work with so many parents with little, little little, you know, and it is, it's, it's scary when it's when it's your child, and it's not even you. You know, the worst thing now can tell the scary story to tell what I think is the funny story.

Scott Benner 10:39
Yeah, so a year and a half later, we're at Disney for the first time. So our first time outside in the heat. On a big day with diabetes like diabetes, the whole day is going great. Again, no CGM still using needles. end of the night we're walking back to the hotel and coming at us is a vendor holding these giant popsicles. Remember looking up and seeing them and thinking we're like 200 yards from the hotel, like make a left turn, what are you doing, you know, but it's hot out and it's late. And my kids see those and they're like, Can we have them? And I thought, sure, I'm gonna do what the doctor told me to do. I counted the carbs, I gave her the insulin. And of course, it turns out I know now, you know, I could have just let her eat that popsicle. It would have been It was a fast acting car but might have hit her spider a little bit and gone away. I didn't eat any of it. But there we are back in the hotel room. Packing again, always packing with seizures in my house. And so we're packing because we're leaving the next day. She's laying in a bed often another room sound asleep, and I hear that noise again. And this time instead of being confused and thrown off, I say to my wife Arden's having a seizure. Now remember, it's been a year and a half since it happened before. And my wife runs and grabs Arden brings her back, she's holding her and I have the glucose gel and this squeezy tube. Now the gel we owned, you had to screw the top off of them pull the foil thing often, I guess CalFresh

Unknown Speaker 12:08
and then you can use as a gel spoil.

Scott Benner 12:12
Cuz you never cut you know, because honestly now in the of course the ensuing 12 years later, we've never Arden's never had a seizure since then, but right, so I unscrew the cap, and I go to squirt out the gel, and I don't pull off the foil cover. And I squeeze it so hard with so much enthusiasm that a pinhole breaks on the opposite side of the thing. And I'm squeezing and I'm like what's going on and then I look up and on the ceiling of the hotel room is a kaleidoscope of gel, I'm shooting all over the ceiling. So I don't even pause I flipped the thing upside down. And now I just scored it from the pinhole into Arden's mouth, we rubbed around, she wakes up, we put you know, get everything straight, put her back to bed, we were traveling with my brother, when it was all over and to say that it might have been a four minute experience, right? When it was all over, I look in the corner and my brother is cowering in the corner, just with a look on his face. Like he can't believe what he just saw. And my wife and I look up and see the gel on the ceiling, we crack up laughing, wipe off the ceiling, clean it up and go back to packing

Jennifer Smith, CDE 13:14
experience is a good example of the fear.

Scott Benner 13:18
That's exactly right. Because no matter how much I explained it to him, and I said, Look, you know, I don't want to call this the cost of doing business. But we've never been in this situation before we're completely blind. We don't know what our blood sugar's doing. I think the point is this. My point is this. I don't think my point is this. I know my point is this. I don't want to have a seizure. But in Geez, two to 15. In 13 years of having type one diabetes, it's happened twice. It was both when she was tiny. It was both when I didn't know what I was doing. And it was well before the technology that exists now.

Jennifer Smith, CDE 13:52
And before experience of walking around. I mean, in this example, walking around a park all day and not really knowing, hey, she could probably get away with having this little bit of extra sugar, she'll climb, she'll come back down, the exercise is going to hit all night long. She doesn't need insulin, you didn't know that

Scott Benner 14:09
no idea. And now I do. And now Arden can go play softball for nine hours on 105 degree day and she doesn't get low at the end of the day. Because now I know what I'm doing. But I fear that exists exists for that reason. And so I don't know how comfortable you are talking about this because I haven't asked you ahead of time, but how real and this then we'll get off the fear and we'll move on to other stuff about insulin, but how real is the concern that I'm going to go to bed one night and not wake up the next

Jennifer Smith, CDE 14:41
day? I would say that the concern? It's a real concern. 100 Absolutely. It is. Is it a concern that it could happen? wildly out of the blue with and I bring this up With the technology we have today, I would say is that piece is, it's not going to be as common. And it's not because we have alarms and things that set now is technology always perfect. No mean, we can get alarms and alerts for blood sugars that are ultra low or look like they've dropped off the map and you do a finger stick, and it's that the sensor was not right, you know, it was a, you know, a kind of a compression low, or you could have a low alert, and you could actually be lower than the low alert already, right. However, the fear of going to bed and not waking up. While I would believe that it's there, for 90% of people with diabetes, the other percent, maybe don't even think about it or know that it's a potential again, education piece there. But I think that there is the knowing about insulin and action going into that time of the night. I think that's a piece that can really help to prevent that from happening.

Scott Benner 16:10
As we move forward, you'll hear me say a number of times that I think that highs cause lows, because highs create situations where you have unbalanced insulin. And and eventually, like we talked about earlier, body function, blood sugar will will be pushed away by the insolence they're leaving more insulin behind. And there are a lot of times that people will say to me, you know, I get low at 2am. Or, you know, it always happens. And I think well, I don't know that you get low at 2am. It's very possible it's something's happening hours before or you're using insulin hours before. And it's and this is what the residual of that. Right. And so when you use insulin more thoughtfully, I guess is the word. Right? Yeah, that's a great word. You don't have as much of it laying around later in your body that has nothing to do except for to make you low. Correct. And I'm hoping that we get to that as we speak, you've addressed fear and insulin, it's a real thing. It exists for most people. There's good reasons why you should be afraid. But how do we stop people from being afraid?

Jennifer Smith, CDE 17:16
But I think the fear too, and just to kind of clarify there, it's okay to be afraid. But it's also really important that you do something to understand and, and be able to get rid of the fear. It will be there it is certainly, but it's important to learn how to not worry so much with the fear. Let

Scott Benner 17:41
it overtake you. I think of it let it overtake you. Like they tell you with fire when you're three years old? Yes. You have to respect fire. But you can't be afraid of it. Right? Yeah, be afraid of it. Exactly. Yeah. And that that's what I do. I it was the first leap that I made that brought me to the place where I am now. And I think that I think that no matter what tools you give people, if they're afraid to use them to kind of, it's never going to work out quite right. And it's always going to become unbalanced, they're always going to end up in a situation where they go see, look, this is diabetes is unpredictable. And and this is always going to happen and then you know, and that that's that so Okay, so all right. So what's the first step to not being afraid? It's got to be understanding how to use the insulin, right? Absolutely. Okay. All right. So we're gonna get

Jennifer Smith, CDE 18:31
100% 100% Yeah,

Scott Benner 18:33
so let's understand a couple of things. First, that the insulin can do the cause issues for people and one, right people say, I started using insulin, and I started gaining weight. Okay, now, very recently, I had an interview with Chris Rutan, where Chris said, That's not as really nearly as much about the insulin is, as it is about calories. And that was his take on it. Like if you eat extra calories, you're going to gain weight. And that a lot of times we have low blood sugars that we treat with food, but we don't think of that food as we think of it as as necessary because it is not because you're alone, right. But what is the act what is the what is the the technical reason why people see weight gain with insulin. Elizabeth forest was diagnosed with Type One Diabetes. At 10 years old. Then a student in Holly recurs dance class, Elizabeth decide to start a nonprofit organization. Now this wasn't something that she had considered previously, but either was being diagnosed with type one. But after her diagnosis, she was driven to not let diabetes negatively impact her life. And she was inspired to start dancing for diabetes. She did this as a way to bring attention to the stories of the 1.2 5 million Americans who are living everyday with type one and to offer support to those who have been diagnosed and on top of all that she's raising funds to find a cure. started as a community fundraiser organized by a middle school student and a small group of trusted advisors has blossomed into a full scale theatrical production involving hundreds of local dancers and community supporters. Dancing for diabetes has been impacting people through dance for almost 20 years. It has grown from a middle school auditorium to filling Orlando's Bob Carr theater, and is well considered one of Orlando's premier charity entertainment events of the year. I spoke last year at one of their events, and had such an amazing time that I'm going back again in 2019. Elizabeth doesn't have a ton of money to do advertising, but she wants to spread the word about dancing for diabetes, which is why you hear during some of our episodes, I just pop in and say the name really quickly. They're trying to build awareness for their organization, while building a better future for people with type one. So you've heard me say before, and I'm going to say it right here. good at dancing for diabetes.com that's dancing the number four diabetes.com check out what they're doing. It'll put a smile on your face, and maybe you'll decide to get involved. Real good foods believes in making delicious foods, high in protein, low in carbs that are made from real ingredients so you can feel the goodness. You'll never find weird sounding words on their ingredients labels, nor will you find processed grains, flours or other fillers. For example, instead of flour. Their Single Serve pizza crust is made from two ingredients. All natural chicken breast and parmesan cheese. Real good foods family sized cauliflower pizza crust is made from cauliflower, egg and cheese, and all of their foods are grain free, gluten free and use natural ingredients. That includes my wife's favorite enchiladas. The poppers that I love so much the chicken crust pizza Arden adores, and the cauliflower pizza that my mom can't get enough for being a listener of the Juicebox Podcast real good foods would like to offer you 20% off of your entire order. All you have to do with Checkout is use the offer code juice box. And as if that wasn't enough, they also have free two day shipping. Let's hold up some of real good foods products against popular competitors. Their Margarita cauliflower pizza has nine grams of carbs and 20 grams of protein. That other pizza that you know about has 37 grams of carbs, and only 12 grams of protein. Real good foods enchiladas has four grams of carbs 20 grams of protein, and that other one that you know about has 18 grams of carbs and nine protein. Now on to the poppers, there must be even somewhere right? Nope, not even close three grams of carbs for real good foods 29 for the competitor, and protein 22 to four, you can use the links in your show notes or Juicebox podcast.com for both dancing for diabetes and real good foods. And don't forget when you get to real good foods calm to use the offer code juicebox at checkout to save 20% Why do some people see weight gain with insulin?

Jennifer Smith, CDE 23:04
The easy answer there is that the insulin is being it's being mismanaged the dosing of it is being mismanaged and mismanaged Why? That takes in depth analysis of what's going on in the person's individual settings. Right? The and I work with a lot of people weight management wise, type one who I you know, I just I've gained weight or I've done this my blood sugar's are no better, but I've gained weight. Now, if the start with if you're running really consistently high blood sugars, you're actually eating out calories. you're peeing out glucose, because that's how your body is trying to get rid of the excess because there's not enough insulin there to bring it into your body and utilize it. So you may be maintaining a weight that you love. Your blood sugars are high that it's that healthy. On the second side, once you do reign in control, and you're now taking insulin to contain blood sugars, you may be gaining weight, because your body is now retaining some of those calories that were being lost before that you didn't realize, right? So that comes down to the point of understanding lifestyle and the management of insulin. And I bring up a really important piece that people don't, people don't realize. Insulin insulins job is a storage hormone. Insulin job is to pack the food into different places in the body. Right? It either packs it and moves it into your muscle cells or at packs it and moves it into fat. Right? It's usable or it's going to be hopefully used later. If there's too much of it, your body has to pack it away and utilize it later. So that's a that's a lifestyle piece. That's something to look at and say okay, where's my activity? level where it is my nutrition intake need to be is my insulin matching that, am I driving my glucose values too low and like you said, am I taking in too much because of low blood sugars that are consistently happening, and then you're adding more insulin to correct the high that follows and then you're dropping and you're adding food and you're correcting and add. So it becomes this vicious cycle of management, if you don't understand how insulin works. And in a body, I think a good point is that in a body without diabetes, insulin plays a very big role in weight management. And people without diabetes aren't injecting it, their pancreas is making it. So if they're themselves not managing lifestyle, they're having to produce a heck of a lot more insulin, to bring food out of their bloodstream for their body to maintain that normal blood sugar, the way that it's meant to do, they will likely gain weight too.

Scott Benner 25:58
So do me a favor and go over that cycle for a second. I take something in through my mouth that has carbohydrates in it, it goes into my stomach, my bag, my body begins to break it down. It basically those carbs are leached out that sugar, which is the you know, sugar is carbs a sugar comes out. And the insulin actually helps it go into my blood, right it or how does it

Jennifer Smith, CDE 26:24
insulin takes insulin, you know, we take it, we inject it or we pump it into our sub q tissue, it gets absorbed and dissipates that into our bloodstream is I guess the easiest way to say how it works. Insulin in the bloodstream then matches with the glucose from the food that we've eaten in whatever form you know, it could be rice, it could be celery, it could be an apple, whatever it is, sugar in the bloodstream, the insulin and combines with the glucose, they latch on together, and insulin is then the key to the door on the cells. With insulin, the doors open, the key unlocks the door on the cell, the glucose is allowed to enter the cell muscle cells then use it for energy. fat cells, pack it away. So

Scott Benner 27:16
that's how it works. And so with so without insulin, we go into DK, right and so and DK is what is it technically, but what what is it that's happening.

Jennifer Smith, CDE 27:29
So technically, with DK a, it's a significant deficit of insulin with high blood sugars. Right now there are cases of aka at more normal blood sugars. dk however, really is it's a deficit of insulin, meaning that your body is has no way to clear the glucose out of the bloodstream and move it into the places it needs to go. Now your body tries to compensate, like I mentioned before, with the weight management piece, if it tries to compensate, you get really, really thirsty with higher blood sugars. You take in more fluids your body up because you're drinking more, and your body is trying to flush a lot of that extra glucose out. And the only way it can if it can't do that forever, though, at a deficit of insulin. And so your body at the point of not having energy from glucose, it starts to break down fats and proteins. So ketones are produced with the breakdown of fat.

Scott Benner 28:31
Is that why? When I think back on Arden's diagnosis prior to it, she was ravenously hungry at the end, because she her body was starving, and it's telling her eat, we're starving, except the food went in. And then there was no insulin to move it into the cells where it was needed.

Jennifer Smith, CDE 28:49
Correct? Correct. I mean, I could have I remember, I mean, I was older than your daughter and I very, I very much remember the two weeks leading up, especially the week leading up to my diagnosis. I very much remember it. I mean, I at the lunch table in school with my friends. I was asking them for their milk. I was so thirsty and so hungry. And so they would they would get two milks, and they would bring one for me. I mean, I was consuming probably six of those little cartons of milk at every lunch and between classes in the hallway. I needed to get to the water fountain. I mean it was it was unbelievable. The unquenchable thirst and hunger.

Scott Benner 29:35
It really is. A threw me off for a second think of it. No, I won't get back on Arden's diagnosis in it. It just it always just makes me think like how do I not see her dying because she was, you know, no insulin in her body and she was withering away. And he looked back at a two

Jennifer Smith, CDE 29:51
year old it is. I think for kids, it's hard to because kids are hungry all the time. I mean, I've got a two year old and a six year old and man, like every hour, they're like I'm home. Hungry rabbits. I am hungry. Can I have that kids are hungry? Yeah. But it's a different it's a very different ravenous

Scott Benner 30:08
in that setting. Oh my god. Yeah. And so let me ask you something when a blood sugar starts to get low with a person who's being managed, but maybe they have there's their insolence on balance and they're getting lower. Arden will say she's hungry prior to a low blood sugar. And I always tell her Hey, if you feel hungry, first thing we should think about is is Are you hungry? Hungry? Or is your blood sugar getting lower about the same function right there?

Jennifer Smith, CDE 30:33
in a in a similar way, just in an opposite, you know, high blood sugars, you're hungry because your body is starving for the energy. Right? And it's not getting it. Low blood sugars. You're hungry because again, as we talked about, initially, your brain is being deprived. Okay? Your brain is saying, hey, you're hungry. There's not enough go grab something. There's not enough food here. I there's, there's too much of this insulin, it's calling. And sometimes even that precipitous drop in blood sugar that can happen. That's why overindulgence is there with low is I mean, you could literally go to the refrigerator and eat the whole roof. I mean, there there are people who have done that, or just the whole box of cereal. And they're like, okay, where's the next box? You know?

Scott Benner 31:24
It's Yeah, and it's commonly referred to as ether kitchen. Right? Yeah. So yeah. And, and, and so but when Arden was younger, and before sensor technology, and I was staring at her trying to figure out ways to understand where her blood sugar was. One of them was if she said she was hungry at what I thought were odd times of day. I thought, ooh, she might be low. And yeah, yeah, because the looking for the bags under their eyes was not working. I'll never forget, she's diagnosed and the nurse practitioner goes, you know, dark circles under the eyes could be signs of low blood sugar. And then she paused and she goes, or high blood sugar. And I was like, Wait, what? Was that gonna help me? And by the way, it never came to fruition. I spent No, I spent the first year for diagnosis, staring at her face looking for a sign of something wrong with their blood sugar, and it doesn't exist.

Jennifer Smith, CDE 32:13
I have never heard that before Scott in that, right. Yeah. Never heard that as a symptom of high.

Scott Benner 32:21
And it makes me think of the insanity of like when the Arden will say to me, like, you know, you'll be in the middle of a CGM changeover. And I'll say, hey, look, it's been an hour since we reset the CGM, or since we put it on whatever, why don't you go ahead and test let's just make sure we are very thing. Sure. And she'll say, I feel fine. And I always go, ironically, how you feel is not the best indication of what your blood sugar. So and so she still won't wrap it, she still doesn't wrap her head around that right away? If she feels Okay, then she thinks I'm okay. You know,

Jennifer Smith, CDE 32:54
well, and there are some children that have not quite even gotten to the point of realizing what the difference of body feeling is. Right. And if they've lived with diabetes long enough, they may not necessarily know what quote unquote, normal should feel like, right? They may not know that your diagnosis at two or three, they're not even realizing outside of like an ear ache that they're like screaming in pain, or they're pointing at their mouth, because they're two hertz or whatever it might be a kid that young are not in tune with

Scott Benner 33:35
other bodies supposed to feel

Jennifer Smith, CDE 33:36
and and associating it with Oh, I'm low Mommy, or I have a high blood sugar. And so then moving on through life, because they've had diabetes, from such an early age, when you do start to make those connections. It's very difficult to translate that then into, you know, older age.

Scott Benner 33:56
So I was it's funny, you brought that up, because this was gonna be my next question for you. So I just was interacting with somebody on Instagram, who, you know, found the podcast is bringing their blood sugar down, and they have a beautiful stable 85 blood sugar where they feel dizzy. Yeah, okay, now, so I'm talking to this woman, and she says, I'm going to ignore it. I know, it's not real. Like, I know, I'm not in trouble. So I'm just gonna power through maybe I'll give myself a little bit of carbs to you know, kind of help it a little bit, but I'm gonna power through it. Because I know my body's going to adjust to this. And I spoke to a different person who said that they got to that that nice, stable, good number and they stopped themselves from eating too much. But it still they had trouble doing it. So my question is, when you've spent such a long time with an elevated blood sugar, you know, thinking 180 was a great day, you know, or your 250 for six of the hours of the day and you finally get this all under control. You keep listening to these podcast episodes, and you get to A place where you're 85 and stable. When that first happens, you feel like you're low? What's the function of that, first of all, and tell people that it's going to get better, please?

Jennifer Smith, CDE 35:11
Yeah, I mean, the function of that is because your body is having to adjust the values that it hasn't seen as the norm, you know, an average of one at an average of 200, an average of 250. While it's high, you're you may feel normal at that, because you don't know what a normal value or a target value feels like. So as you start to notch things down, your body has to readjust to that new normal value, and it does take some time. So hovering, you know, now at even 110. For somebody who is averaging 200, they may feel low, that may very well feel low, it doesn't mean it needs treatment, is it's truly not a low value, but it does feel low. And so it's hard. It's hard to work through that. I

Scott Benner 36:10
don't know. But I can imagine. Yeah,

Jennifer Smith, CDE 36:12
yeah, yeah. So I, you know, I think as far as CGM, especially I think that's, that's good technology now that at least they can also see where things are going. I mean, if they're at 110, feeling low, and they're all where, all right, they're consistently still dropping very much, especially, you know, fingerstick wise, they might be lower than that. If they're on a trend, if they're hovering nice and stable, nice horizontal line at 110.

No need to treat that fight through it.

Scott Benner 36:39
How long does it I realized it'll be different for everybody. But what's the average amount of time before stable in range, blood sugar starts feeling normal,

Jennifer Smith, CDE 36:48
usually, at least a couple weeks. I mean, from starting, you know, the end, depending on timeframe of how long things were higher, it may take a couple of weeks for that to feel normal at those lower in target values. And again, stability there, and lacking this big jump up and down and whatnot, that makes a difference for resetting those symptoms in your body.

Scott Benner 37:16
Okay. I have one last question. And then we're gonna move on to something else. Can

Jennifer Smith, CDE 37:20
I show you my line right now? Yeah, Jerry.

Scott Benner 37:22
But look at you. Okay, I'm looking at at a Jenny six, our Dexcom line that looks like it's been right at 100 it might have dipped to was that Where's your low at 60 or 70? Below that? 7070 it hit 70 for a little while, maybe for about an hour, and then it banged up at 85. This is very, pretty good for you. Are we? Are we gonna? Okay, here we go. Let me compare. So Arden has one compression low in the last 12 hours. That isn't real. But other than that, let's see if you can see that.

Jennifer Smith, CDE 37:59
Very nice. Thank you. She's even averaging lower than me right now.

Scott Benner 38:03
And we as a new it's a new pump too. So I think you've got the best day. Yeah.

Jennifer Smith, CDE 38:09
I know those pod change days are like, it's almost like magic. Well, can be almost like magic.

Scott Benner 38:17
I actually got walked through walk somebody through how to pod change without a high. And we'll talk about that when we talk about pumping. But yeah, so here's my last question about insulin. Let's get I'm gonna go back to something scary for a second. But I think it's, well, I know how impactful it was for me. So back when I had to dispense with my fear of insulin, like we talked about at the beginning. How do you do that? Right? Like how do you make a leap like that for me, and it will probably be different for a lot of people. I started thinking more about long term health, I realized that the doctor was telling me to leave Arden's blood sugar high so that she wouldn't get low. We were trading today's health for tomorrow's right, like we won't die today. But we might not live a long healthy life either. And I thought that can't be okay. But I still couldn't make the leap. And finally, I thought about it in as technical and scientific way as my brain would allow. And what I what I came to, to think about was I actually spilled some sugar out on the table, and I looked at how kind of coarse and granular and sharp it was on its edges. And I thought well at its, you know, at its microscopic, like existence, it's probably still course in sharp like this. And our bodies are built to handle a certain amount of it flowing through our blood. But if you pack that blood with too much, that must be and this was me thinking my way through when people say I he died of a heart attack, you know, because of his diabetes or he went blind because of his diabetes or he couldn't feel his foot anymore. What that really means is that the sugar has basically sandblasted you from the inside, damaging right making damage to the inside of your veins and capillaries, all the places where bloods covered, right? If you have a heart attack, and they say it was because of diabetes, it's because the flesh in your heart got rubbed thin. And it

Jennifer Smith, CDE 40:10
burst. And I mean, and beyond that, beyond that are the other the other pieces of those complications, such as heart disease that come about, and most doctors don't teach this. And I think it you know, it may be a time thing it may be that they don't want to get the in depth piece of it. I think we

Scott Benner 40:35
should I think to bring up on day three of your dying day.

Jennifer Smith, CDE 40:38
Right, exactly. I am blasting yourself. I have a good and I wish that I could show this to everybody. But this is a tube full of a glucose solution. Do you see how slowly those little they're supposed to be particles of sugar are flowing through the bloodstream, yeah, sugar or nutrients, right, I like to refer to them as nutrients. Because this is the other piece to overall Long, long health with diabetes is, as you mentioned, glucose I love your rough part of that example, because it is high glucose levels cause your cause your blood to get sick, almost like molasses in winter, okay, which means that all of the nutrients, your bloodstream are also flowing very slowly to all the places in your body that need to get those wonderful, micro macronutrients. So healing and everything gets slowed. If your glucose levels stay as high as the the roughness of that sugar that you're talking about, or the high glucose values, it is it's very damaging to vessels almost creates like rust on a car, it creates damage on the inside of the vessels, your body tries to heal itself, it's a self healing machine, your body actually makes cholesterol. It's like a band aid. So even if you never eat cholesterol, again, your liver is meant to make cholesterol and cholesterol is like it does a lot of other things. But it is also a patch, the more damage, the more patch, you see how narrow my vessel is now getting the more and more patches, those vessels that narrow, that leads to high blood pressure, high blood pressure damages your kidneys, high blood pressure puts a lot of pressure on the vessels in your eyes. So it's a it's a snowball effect, with consistently maintained high blood sugars now have a 200 blood sugar because you decided to eat the whole, you know, Disney Princess cake or whatever. And then you bring that blood sugar down. That's, that's a different story than this consistent maintenance of high glucose. That's different.

Scott Benner 42:54
Yeah, right. I think that when people when I say that ardens A once has been between five and six to four or five years, I think people imagine a steady 85 blood sugar forever, which is not the case. Right? She spikes up just like everyone else, you know, if you're gonna if you're gonna eat with diabetes, and not have, you know, you know, not not have boiled it down to low carb or no carb or something like that, right? You're gonna miss sometimes I miss on boluses. You know, insulin pump sets aren't as effective on day three as they are in day one. There's reasons why right? Yeah. So it really is. It's not a perfection you're looking for it's a it's a fluidity of fluidity, it's a consistency to how you manage that's what keeps your eight, one clo, right, as you were describing cholesterol coming in and making patches on, you know, arteries or veins. And it it thinning, you know, that's what people would commonly think of as needing a stent in their heart, right? Like, eventually, it has to open up that space again. Right. So for me back to what I started to say, I got past the fear by saying to myself, I can't let my fear of something happening to art and today affect her entire life. Right? I just can't do that. And, and if that means she's gonna have something bad happened to her or my life's gonna be a little more hectic managing insulin, then that's got to be what it's got to be. right because the alternative is I put all this effort and heart and love into my daughter and at the end of my life when I'm 65 7080 years old, and I'm looking back at my 40 year old daughter and she's in incredibly poor health. I'm gonna think like, what was this all for? Like, you know what I mean? Like what I spend my whole life doing so I'd rather get in the game now and do the best I can let the chips fall where they may a little bit. Then just to ignore it. I can't I am not across that bridge when it comes to IT person. I find I find when you think about life like that. People have heard me talk about it on the show before you get a bill. The mail you can't afford it. And you know, you can't before you open up the envelope, just open it anyway. Right? Be an adult and go, I owe the electric company $400. Like, right?

Jennifer Smith, CDE 45:09
No, that's not going to be better tomorrow, it's gonna be the same bill. Absolutely.

Scott Benner 45:13
It's the same idea with your blood sugar. Like, don't ignore it. Don't say to yourself, that's okay. I'll deal with it later, because later is going to be worse. Now Sox laters worse. So, get in the game, do it. Now.

Jennifer Smith, CDE 45:27
I've always thought about myself, personally, I've always thought about all the things that I am able to do be, because I choose to manage because I have chosen to understand how to manage. I mean, I, I've done a lot of awesome things. I've had two kids, I, you know, I want to see those kids grow up, I want to be around with them. And that, that is the biggest thing to look out to future wise. And remember every day

Scott Benner 46:01
it is, and that's why you and I are doing this like series inside of a it's a it's a series of podcast episodes inside of a podcast. Right? Right. It's because somebody is going to hear that and think, yeah, that's nice, buddy. But I don't know how to keep my kids blood sugar at 70 and blah, blah. But I'm telling you, we're going to talk about how to do that in a way where you don't have to, when you hear the idea of keeping your blood sugar stable to lower number, it doesn't make you think, well, that's impossible. We're, we're going to talk about the tools that make it possible. And I'll leave this episode with this thought. Three nights ago, a man in his 40s I saw him on Facebook, and he was basically begging people, he was at the end of his rope. And he had had diabetes for a long time. And it was just not going well. And people are all jumping in giving them giving him their best piece of advice. And I always think the same thing. When I see people on social media. I'm like, wow, that's valuable. But how do you make sense of it, you know, then somebody else say something else. And I go, Well, that's not really that valuable at all in this situation. But I say why it's well meaning. And so then the person's frazzled, to the point where they thought to reach out into the world to strangers, right. And now these strangers are throwing 20 ideas at them. None of them are cohesive, even if they're good. And so I just couldn't take it. And I, I stepped in and I said, if you want to message me, I'll see if I can help you with this. And there were very kind people who all jumped on and said, I would mesh it, Scott if I was you. So we got we got on the phone. And 45 minutes later, we got off the phone. And the next morning, he sent me his steady overnight graph. And to that day, he sent me his 30 day graph, and the next day, and the next day. And my point is, I can't talk to all of you on the phone and Jenny can't speak personally. But I think we can give you enough tools to get you to that spot. So so keep going with the with this series. And I think you're gonna be happy that you did. I hope you're enjoying the series, I want to take a moment to thank the sponsors dancing for diabetes, real good foods. And even though they weren't mentioned in this episode decks comment on the pod. There are links in your show notes, and at Juicebox podcast.com to all of the sponsors. But you can always go to dancing the number four diabetes.com real good foods.com use the offer code juicebox dexcom.com, slash juicebox. Or my omnipod.com slash juice box to find out more. And don't forget that Jenny does this for a living. And you can find out more about her services at integrated diabetes calm. This episode with Jenny Smith is of course part of a series if you missed the first two, there was diabetes pro tip newly diagnosed you're starting over and diabetes pro tip all about MDI. This, of course, was diabetes pro tip all about insulin. Now if you enjoy these episodes and found them useful, please go to iTunes and leave a rating and review. Over the next few weeks, you'll get the same interview style episodes that you've come to enjoy. And then towards the end of the month, three more episodes coming your way. All About bolusing basal rates pumping glucose monitoring the next steps in this bigger picture. And when Jenny and I finished with these 10 episodes, it's our goal for them to be a roadmap sort of a blueprint for how to use insulin and manage day to day with type one. I also imagine that there may be times during conversational episodes where you hear an idea brought up and you may be able to come back to these episodes for you know a refresher on the concept. Thank you very much for listening to the Juicebox Podcast. I'll see you next week.


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