#899 Diabetes Pro Tip: Transitioning
Diabetes Pro Tip: Transitioning
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
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Scott Benner 0:00
Hello friends, and welcome to episode 899 of the Juicebox Podcast.
My diabetes Pro Tip series for type one diabetes began in February of 2019. Today I'm adding another episode. Jenny Smith and I are going to be talking about transitioning. We're going to do an overview of transitioning from your blood glucose meter to a CGM, from MDI, to pumping from pumping to algorithm pumping. And at the end of the episode, I'm going to add feedback from Juicebox Podcast listeners about all of these topics. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. If you'd like to help type one diabetes research, all you have to do is complete the survey AT T one D exchange.org. Forward slash juicebox. The T one D exchange is looking for US residents who have type one diabetes, or are the caregiver of someone with type one to complete a very short and simple survey. The answers that you give will help move type one research forward T one D exchange.org. Forward slash juicebox.
The diabetes Pro Tip series from the Juicebox Podcast began on February 25 2019, with an episode called newly diagnosed restarting over after that episode 211 was all about MDI episode 212 all about insulin, Episode 217 Pre-Bolus Singh, Episode 218 Temp Basal 219 Insulin pumping to 24 mastering a CGM to 25 Bump and nudge to 26 the perfect Bolus to 31 variables 237 setting Basal insulin 256 Exercise 263 fat and protein 287 illness injury and surgery episode 301 was glucagon and low blood sugars episode 307 Emergency Room protocols episode 311 long term health 350 Bumping nudge to 360 for pregnancy 371 explaining type one episode 391 was glycemic index and load 449 postpartum 470 weight loss 608 Honeymoon 612 female hormones and today episode 899 transitioning, you can find these episodes in your audio app Spotify, Apple podcasts or anywhere you get audio. You can also find them at juicebox podcast.com. And at diabetes pro tip.com. As always, these episodes and the entire podcast are absolutely free for you to listen to the information inside of this podcast. And more specifically inside of this Pro Tip series. This information is at the core of how my daughter has kept her a one C between five two and six two for over eight years without diet restrictions. Myself and Jenny Smith Jenny of course is a CDE who works at integrated diabetes.com Jenny and I we go over the topics go over the ideas in easy to listen to and digestible ways you can apply this information to your life whether you're an adult with type one who's been living with it forever, or a parent whose child was just diagnosed, I implore you to check out the entire series. It really will help. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy Earth sells sheets and towels and joggers and comfortable things really that's what I should have said cozy Earth has comfortable things whether it's sheets or towels or clothing. It is soft, it is warm. Unless you don't want it to be warmed I don't even know how to describe the sheets or they keep you cool or they keep you warm. Depends on what you want. I don't even like I don't know if there's a word for it but your body is temperate in it is temporary the word. I looked it up it is a word it. How do I put this? I wear my cozy Earth gear on an airplane the other day. I wasn't too hot. I wasn't too cold. When I got home. I got my bed with my cozy Earth sheets. I wasn't too hot. I wasn't too cold. Everything is soft. It feels terrific. Check it out at cozy earth.com where the offer code juice box will save you 35% at checkout The podcast has a number of long term sponsors, Omni pod Dexcom contour G voc, US med touched by type one, athletic greens. Of course, you heard about the T one D exchange earlier cozy earth. All of these sponsors are prominently displayed at juicebox podcast.com. Or in the show notes of the podcast player you're listening in right now, when you support those sponsors by clicking on my links or typing in those web addresses, you are supporting the production of this podcast. So please, if you have the need, use my link. What I would like to talk about today is transition. Just a an overview concept for this one, but transition from just finger sticks to CGM transition from MDI, two pumping, transition from pumping to algorithm. Sure, can we do that? Yeah. All right. I thought we could all thank Isabel here for having her finger on the pulse of the people in the Facebook group and knowing exactly what people ask about, and what they seem most confused about. Why don't we start with MDI, because everybody starts there, right? After you're, you're doing it for a while, like, let's put ourselves in that place. We've been doing MDI for a while it's working pretty well, or at least at a baseline. We're shooting a Basal insulin once a day, and we are shooting a meal insulin to correct blood sugars and to cover our carbs. That's the basics of MDI. Okay, correct. So then we're in a doctor's office, but I'm gonna make up some numbers. Let's, let's say our basil. It's like, I don't know, let's say our basil is 10 a day. And let's say were, I don't know, one to 10 for carb ratio. Okay. All right. Let's say our correction is one to 100. Let's keep it all very like, like that, so that it's easier to talk about. Okay, round 10 numbers and numbers, we're gonna do that. So the math makes sense when people are listening. So we're in the doctor's office, and the doctor says, you know, you might like a pump?
Jennifer Smith, CDE 7:24
Is he gonna say it just like that?
Scott Benner 7:25
I mean, if it's a lady, she might be like, You made like a bump? I don't know, like, people are anywhere in between. There's some women have more masculine voices, Jenny, this isn't the point of what we're talking about. Yeah. So they see, you might like a pump. You are. I'm guessing, gonna have a couple of different reactions. I see a lot of people scared. Oh, no, don't change something. I see a lot of people are like, yes, please, because this isn't working. And maybe this will they don't know why they think that just right, they're hoping for a change. So the first thing that's going to happen is the doctor is going to translate your Basal insulin to this pump. So Jenny, you do that math for me? I correct I get 10 units a day injection, what are they going to do on the pump for me
Jennifer Smith, CDE 8:13
most often on a pump, because it's expected that your Basal insulin which and this is kind of outside of it, but within your Basal insulin will now be given by the pump as rapid acting insulin. So that's the first thing to understand is that you're injected Basal insulin, which is a specific long acting kind of insulin will now sit in your refrigerator as a backup in case of pump failure, right? So you don't put Basal insulin into a pump. The only insulin that goes in the pump is your rapid acting insulin of any of the brands, right. Depending on the pump, company, they all have a little bit of different kind of recommendations for type of rapid insulin, but it's a rapid insulin and to translate your Basal dose of what we said 10 units into a pumped Basal delivery, you would essentially take 10 units into a 24 hour day. Right? And that translates into a a dripped amount, right? Because insulin pumps drip drip, drip drip consistently to deliver that total amount of basil that you want.
Scott Benner 9:32
Okay, so let's clean it up for people who get lost very easily. You may be injecting trusty Abba love Amira, Lantis what are the other ones,
Jennifer Smith, CDE 9:43
Basil Glar or these are all based in jail.
Scott Benner 9:46
These are basil insulins. These are now gone. You don't use those anymore, because as Jenny points out, you're going to take your mealtime or your fast acting correction insulin, put it in the pump, and it's going to split it up. Those 10 units are going to get split up Over, not just over hours, that's how the settings the pump work, right? You're gonna come up with what is it going to be like point four, maybe an hour if you're 10 a day about like that, right?
Jennifer Smith, CDE 10:10
Right, depending on your pump, all of the pumps differ in their precision of a single drip of insulin. Some pumps can drip as little as point one, one, some can drip as little as point oh, two, five or point oh, five. So it just depends. But if you broke this down 10 units a day into 24 hours a day would be a rate of about point four, two, if you do rounding, right? Yes, some pumps, you may have to round that 2.4, because they can't deliver the point oh two.
Scott Benner 10:42
And you're, you're gonna hear that if you're MBI. and think, oh, at the top of every hour, it's gonna give me point 14 incidents on but it's not doing that it's going to break the rack to wait for Twos Up over the entire hour
Jennifer Smith, CDE 10:53
over the course of the time. Exactly. Now, the other step to this calculation is that we expect that your Basal insulin you've been injecting I'm trying to think how to say it. So people don't think their insulin is not working. But when you inject Basal insulin as its type it, it will not be absorbed as efficiently I guess is the better way to say it as it would from a pump where it gets infused in those little tiny drips over a very precise amount of time, a very precise dose. So your rapid insulin in your pump gets infused out of sight. And so we usually take your base Basal dose down by about 10%. Some, some physicians even go down by 20%. But the general idea is taking your base dose down by 10%. So 10 units a day taken down by 10% is one unit less, so nine units instead of 10 units. So if you do the math there, nine into 24 gets your rate down instead of point, let's call it point for an hour, down 2.37 an hour, which again, we'd probably round down to point three, five.
Scott Benner 12:05
And you're going to want to keep an eye on that because I've seen it go either way. I've seen that be right. And it's amazing. I've seen that be now not enough insulin, and people are getting high blood sugars. And they immediately like you hear them say like the pump doesn't work like well, you gave yourself less insulin and turns out you need right. So pay close attention to that.
Jennifer Smith, CDE 12:27
It also translates into the next step. Once you've been making some notes on this 24 hour dose of let's call it point three, five units an hour. And you can say Well, it seems okay here. But then at this time of the day, I'm always high no matter what I can skip eating and I'm high I can eat and I go even higher. Well, that's when the next step is Basal testing. Right, we need to really look at it and say, where is that point? Three, five, sufficient and where is it not? And where might it be too much.
Scott Benner 13:01
And you might notice, and this, this might sound a little heavy if you're thinking of switching but you could put your pump on your belly and have a different reaction to the insulin that is if it's on your hip or your thigh, you know, there's reasons like Arden's thigh doesn't work as well as her stomach does,
Jennifer Smith, CDE 13:19
you know, neither does mine, I don't use my thighs anymore. Yeah, back of your arm might
Scott Benner 13:23
be better than your, the back of your butt. Or who knows, like right and with
Jennifer Smith, CDE 13:27
with this being new from coming from MDI, to going to using a pump, I would suggest initially utilizing and testing out within an area of the body, you know, we talk a lot about rotation, not only should you be rotating, if you're doing MDI, your injection should be going multiple different places, not just the same site over and over. The same goes along with pumping, those sites need to be rotated. If you're new to pumping, however, you really want to get an idea if your settings are fairly good. Stick with rotating around your abdomen, right? Get an idea. And then once you have that fairly well set, you can then move to upper body or the back of the arm or maybe your thigh or you know your lower back and see if you notice any difference some people do and some people don't at all.
Scott Benner 14:19
No, right? No. I mean, there's it's your body composition, hydration, how you know where it's actually going inside of you. Is it subcutaneous Is it very close to a muscle? We don't overwhelm people, but the muscle can kind of I don't know what the term is like what a large muscle group can. It kind of lessens the impact of the insulin but for the life of me, I can't think of why right now. Do you know what I mean?
Jennifer Smith, CDE 14:44
lessons? I know I don't know what you mean.
Scott Benner 14:46
I always thought that's why the thigh wasn't a good spot because it was a large muscle.
Jennifer Smith, CDE 14:51
Well, it might have more to do with how well the insulin at that site is getting absorbed. Like that's a big reason that I don't use My thighs is because whenever I tried using it, either I got a clusion alarms because the cannula was bumping into muscle or potentially that I had nicked, like a small vessel under and it had been clouded kind of near that site were was trying to infuse. And so that backs up into the pump and the pump tells you hey, the delivery of insulin has stopped. It gives you nice alarms. Right? So I think in some cases that may be part of the issue is the proximity to muscle, yes. But also I it was either painful or I got occlusions like it just never worked on my thighs.
Scott Benner 15:41
Okay, I'll say, Look, I'm learning from the podcast. Finally. Finally, I learned about this every day, you learn a lot. Okay, so now we've, I think here's a good place to insert that it is possible that there are some people on MDI who are achieving reasonable lower blood sugar's some how do I say this? Sometimes your doctors over baseline you because they don't think you're covering your food correctly. And
Jennifer Smith, CDE 16:12
or they may not have looked at your records enough to know why they've you know what I mean? Like, it might just be easier to backup with enough Basil with what they're seeing in your data. Yeah. And it may as you're saying, it might be wrong,
Scott Benner 16:26
right, right. So like, imagine if you're a person who has been getting more basil than they really technically need, but you kind of forget meals, sometimes you don't cover all your food. But now all of a sudden, you have this pump, you're like, Oh, it's so easy. Now, I just push the buttons for my foods, and now you're covering your meals well, and you're like, why am I low all the time? Right? It might be because you're using more insulin than you have been in the past. So those are things to look for that I see people struggle with the beginning with a pump. And I do want to say I think there's a, I think there's a period of transition there. It's not going to be like if you're nervous. It's not unfounded, you know, like you are starting a whole new way of doing something. But it really is just another way of delivering insulin to you. It's not that complicated.
Jennifer Smith, CDE 17:16
And I can say personally, when I switched from MDI, having done MDI, a long time before I started using a pump. By the time I started using a pump I was already doing. I was already doing somewhat of a Pre-Bolus. But it wasn't the same once I switched to a pump, there was a definite time difference between my Pre-Bolus with injections, and there still is, yeah, I can take an injection and my Pre-Bolus Time is not as long as it is on a pump. Right? Again, and of one. But that's what I noticed. And so those are some things to pay attention to between MDI and what you're doing along with what you said about maybe the doses you were taking on MDI, were covering a certain way for your rapid insulin for meals and corrections. And now that you're on a pump, your meals, the food hasn't changed, your strategy has stayed the same. And things are looking
Scott Benner 18:14
weird, right, right there, you do have to step back a lot and try to see what's happening. One reasonable reason for that could be reasonable reason why it wasn't right. But anyway, you use an omni pod and delivers insulin a little slowly. Like it doesn't just like you take a needle and you go Yeah, the pump is pumping over time. And I don't imagine you use very large bonuses, but larger bonuses take longer. I've seen I've sat at a restaurant with Arden and, you know, you forget you've done it and you kind of still here like that, like think like click clicking. It's still giving her insolence feels like it's been five minutes, you know, and yeah, so that's, that could be part of it. Anyway, these are things you're going to learn along the way. They're new lessons, but they're not a reason not just try, because you're going to gain what you're gonna gain so much, right? Like if, to me a pump is at its core, I've always thought of pumping as a way to be able to manipulate basil. Whereas on MDI, I shoot it in, it's in there, nothing left to do. If it's too much, if it's too little, it's what it is, you know, with MD with a with a pump, you know, you can go back and listen to the Pro Tip series. I think about like, wow, if we sit down to a meal, that's all of a sudden much carb heavier than what I usually eat, I could do a Temp Basal increase, they try to help me with this. You know, I was thinking a minute ago when we were talking about breaking the 10 units down into point 4.35 That if you think about putting a sprinkler out on a dry, dry lawn, right, and you need to give your lawn 10 Guys gallons of water, you could come along and dump it on all at once, it'll just be there, that'll be it right, or it could break it up into a little point three, five gallons every hour and go back and forth. And just a light covering, covering, covering, covering, you're never gonna soak it down, you're and it's just I think of basil like sort of like that. Sometimes you're just,
Jennifer Smith, CDE 20:20
and that's a good way to think about it too. Because if you consider that slow Basal drip that you are getting from a pump, when you inject your Basal insulin all in one clump, right? You can, depending on the kind of activity you like to do, you may have found that you have to pay attention to Gosh, I'm doing like a really heavy arm workout, I'm probably not going to inject my Basal insulin into my arm today, I might inject it someplace else, right? Because there's this whopping dose sitting underneath your skin. And any kind of insulin, whether it's rapid, or Basal can get enhanced in action, the more active you are, and especially if you're using that site. So, you know, those are the kinds of things that having those tinier doses that you can manipulate and adjust, especially with the variables that you know, are coming in the day.
Scott Benner 21:21
If somebody's listening and thinking like, well, they have spent the first 15 minutes talking about Basal insulin, it's because it's really important, and nobody tells you it's important setting. So if you listen to this podcast, like while I do MDI, they're always talking about, like, their settings on their pump or anything. This is still settings, you know, if it's MDI, it's your settings, it's, you know, these Basal carb ratio, correction factor, they're all settings. So it's just very important to have them. If they're not accurate to your needs, then everything else is just going to be a mess. And especially Basil, basil is wrong. The whole day is confused. So okay, so we've translated our basil, our insulin to carb ratio, does the doctor keep it the same? Do they usually like what is common?
Jennifer Smith, CDE 22:06
They may keep it the same, especially if your records prove to show that it seems to be for the most part working fairly. Okay. Right? Could there be improvement somewhere, possibly, or whatever, maybe that's also part of the reason that they feel like a pump might actually be better. Maybe you're the kind of person that just eats really slow digesting food. And so you've had problems with taking your insulin and having these big drops in your blood sugar too fast, and then it ends up catching up with you. And then you end up high later, and you've treated low blood sugars, right? And there's not a timing thing that you can really get quite right with MDI. And maybe the doctor says, Well, why don't we try a pump, because hey, you're eating these types of foods more frequently, we could actually use some of the smart features on our conventional pumps that allow you to take some insulin for food, we're calling these extended boluses. And you can just kind of like basil. It's almost like a secondary use of basil. But for a Bolus, where you drip drip, drip drip drip a Bolus in over a certain amount of designated time, you
Scott Benner 23:13
know, there's just, there's so much you're gonna get out of having a pump there, there's also going to be some things you need to know, sites can, like they're going to tell you whatever pump you have, they're gonna say this pump you can wear for X amount of days, or X amount of hours. But sometimes sites go bad. You know, sometimes new sites don't work as well in the beginning. Those are little things that you'll learn along the way. There's, if depending on Arden's blood sugar, she might put on a new pod, and we might just Bolus a little bit to get the site working. This morning. I woke up in the morning, I saw that artists blood sugar was trending up overnight. And listen, for those of you just switching like Arden is looping, but I can see how much insulin is left on a pod remotely, which most of you aren't gonna be able to see. But I can see she was down to like 30 units. So this is the end of her sight, right. And I just spent the weekend with her. And doesn't matter. But we were in a lot of restaurants this weekend. So Arden got a lot of insulin this weekend. And in my heart, her blood sugar is drifting up because this site is kind of done. So because you have experience, yes, I can just tell and you will be able to one day as well. So I sent her a text and I said I wouldn't go to class with this pump one. Because if she does, she's going to spend her whole day with blood sugar around 150 And she's going to be fighting with them constantly. And bolusing and they're not going to work and and by the way, if that happens, and then all of a sudden she gets crazy active out of nowhere. She might experience a low blood sugar from all this insulin kind of sitting in this right over us. Yeah, getting this pole right. And so like that's Here's the thing you'll learn along the way, you'll learn, you know what people worry about so much like, well, you know, do you travel with pumps? If we go too far from our house, we do. If it's a 15 minute turnaround, we don't like, you know, what, I'm gonna have to have insulin with me now, like, I don't know, we don't travel with insulin that frequently, as long as we're in your home base, you know. But if we go far, you know, half hour, 45 minutes, and it's not something we want to turn back from, we'll take insulin with us, you know, you just you, my point is, is that it becomes all second nature at some point. Just like everything else about diabetes, you're gonna have experiences they're going to teach you, you'll learn from them and move on. Speaking of moving on, you'll think I'm gonna go from MDI to pumping, to pumping to algorithm pumping, but I want to do CGM is first. So you have a meter. And that's how you check your blood sugar. And that's all you have. When you're in the doctor's office. The doctor is like, you know what you want to do?
Jennifer Smith, CDE 25:59
It must be the same doctor.
Scott Benner 26:01
I got one of the drawer here. Take this a sample you try. You'll love it. They're gonna try to give you they're gonna say to you, hey, you might want to leave Ray, you might want to Dexcom if you're on a Medtronic pump, they might ask you to do whatever the Medtronic CGM is called. And you're gonna say I don't need that or you're going to be newer. You're gonna Yes, please.
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Wherever you fall on that you do want it. Your insurance covers it you want it? That's for sure. Right? Tell me why.
Jennifer Smith, CDE 28:49
And I think it applies in all realms of diabetes as well. Right? Not just in type one diabetes, but also type two diabetes and even worthwhile and gestational diabetes. I know there are some rules in terms of when it can be prescribed whatnot. But I think it's beneficial all around what you miss with finger sticks are all of the little dots in between. So where things are trending, right, so if it is something that your doctor does bring up? Absolutely say yes. Right. You may not know how to look at the information or what you're getting from it initially. But it's so worthwhile.
Scott Benner 29:30
You want to know what you don't know. And with finger sticks, especially if you're newer to diabetes, or if you just been doing them your whole life and this is how you tend to think of it. You do the well i i test before I eat or I test before I go to bed or I test before I drive. And right. And I know you've asked yourself what's happening when I'm not looking right like and if you haven't asked yourself that. I wonder how do I go from two 50 to 50 in an hour, like how does that happen? And you'll learn you'll start seeing the impacts of activity and the lack of hydration, and different foods that you eat. The age of your, your insulin pumps cite all these different things that have a huge impact on the way your blood sugar moves. And now suddenly, it's there. A CGM is going to show you minute by minute. I think it's every five minutes. Right.
Jennifer Smith, CDE 30:32
And I think there are there are some people who have been using it long enough that can say, there can be some frustration around the amount of data that you get. And I wouldn't disagree with that I but I do think it's how you interact with the data, right? It's how you actually take a look at things and what you do with it and what you learn from it. And you'd have to, you have to expect that in the first month. Let's call it of using a CGM, you're gonna see a lot of stuff. And so rather than being so very emotionally reactive, again, taking a step back and kind of looking at the data to be able to make better decisions about what you felt like was probably happening, and now you can actually see it
Scott Benner 31:21
right. Well imagine you have your sprinkler out on the yard, and you have to keep the dirt moist because you've planted grass seeds, except every time you look out, it's kind of dry. That's the CGM. You look at the CGM ago Oh, from 3am till 6am. My blood sugar's 140. It's pretty stable, but it's 140. I wish it was lower or moister. I can turn up the sprinkler a little and put on a little more insulin and make it where I want it to be like push that number download
Jennifer Smith, CDE 31:48
and the CGM can show you that if you're really looking at it. That way the CGM can show you where did it start to lose? Right effect? Where do I start to need to add more insulin? It's not once you get stuck higher or once you get stuck lower than you want. It's before that so any drifts up or drifts down. You can see that very clearly on a CGM I, you have a really good example I think from when Arden first started using her CGM, it was like that overnight thing that you were constantly missing was at Lowe's when you had finger sticks, and I would put all you could see them.
Scott Benner 32:27
I thought I was a genius. I've said it before I would put Arden to bed at 180. And she'd wake up at 90. And I was like, Look how good I am at this. And what would happen. We put a CGM on her. She was 180, she'd go down to the 50s sit there for hours, I'm assuming her liver would be like, hey here, try not to die. Here's some, you know, here's some, here's some glucagon, I'll give you a little bit. And then she drift up to 90 overnight. It was happening constantly. So the reasons for that are mind numbing is not for this conversation. But we were bad at bolusing for dinner. We were her basil wasn't like there were so many things that weren't right.
Jennifer Smith, CDE 33:03
But you didn't know it because you couldn't see what was happening unless you really did a finger stick even an hourly finger stick, it would have caught a drift. But it still would right? But it would have still been confusing unless you've sat down and you connected all those dots. And you could say, well look, look at this. And you probably I mean not necessarily wanting to see your child sit at 50 for three hours before your body actually reacts and gets you the glucose that is needed to bring it up. But you'd have on a first finger stick probably under 70, you would have ended up treating so you also wouldn't have had the information to show. Well, how much do we need to take away? And what do we need to do differently?
Scott Benner 33:45
I can't I can't say how valuable it is to be able to see a graph and to enter look at it every three hours or you know what's it look like over six hours, like Jenny's point is great as the you you don't know why? What happened happened? It's um, if you're married here, it's nine o'clock at night. And you're now in an argument. Right? And you think I don't know what just happened. But mostly this is guys like they're like what? They searched the last five minutes their brain and I've not done anything wrong in the last five minutes. But if you could step back and see a whole graph of your day, you'd realize that at 630 at dinner, you said something really stupid, and now it's hit me at nine o'clock. So I think that that can be similar. You could have cheeseburger with french fries at dinner at eight o'clock at a restaurant and hit it with a great Bolus. And you're like, oh, wow, my blood sugar's still where I want it to be it's 140 After dinner, that's not bad. And two hours later, it starts to jump up. And that doesn't make any sense to you because you haven't listened to the Pro Tip series. You don't know about the fat and the French fries and the slow digestion and how your blood sugar is gonna go up afterwards. But at least if you see it on a graph, and then you go have those French fries and that burger again. You see it happen again. You can go Oh, I could get get ahead of this, right? Yeah, I could not say that stupid thing at dinner. And now we'd be watching television and she wouldn't be yelling at me.
Jennifer Smith, CDE 35:06
Right. And if you have a pump, you can also address it a different way than waiting for it to finally start rising and getting too high, you can offset it ahead of time knowing what is coming, because you've had the experience that, oh, it always hits around two hours. So I'm going to start doing something about an hour and a half before that. So that it actually doesn't happen. Right. So I mean, yeah, it's million
Scott Benner 35:32
ways to handle that if you're Yes, right. For for art in an hour after she has french fries, we have to Bolus for the fat. And there's a calculation you can do. And there's that heads off that secondary rise and doesn't cause a low later. That's the other great thing is the everyone. When you don't have enough data, you think, Oh, if I just keep throwing more insulin here and there, it's gonna be it's not true. Like you can match the need up with the impact of the insulin and never cause a low, right. And that's something you're going to learn looking at a CGM that, that uh, that a stable line on a CGM is really your insulin, your insulins pulling down and your food and your other impacts are pushing up. And neither of them are winning, like so if you can kind of imagine that line going off into affinity nice and stable. There's invisible lines. cables attached to it. One's trying to pull it up. One's trying to pull the line down, and neither can win because you have a great balance between your insulin and your knee. Yeah, so that in the CGM, like, seriously, like, I don't care, like there's Dex comms and advertiser, it's not like I'm saying that like, get a CGM. It's of any,
Jennifer Smith, CDE 36:43
right? Absolutely. I mean, I've said before, many times if somebody was going to take my technology, I would fight for my CGM. Before I'd fight for my palm. Yeah, no 100% would keep my CGM.
Scott Benner 36:58
I'll throw this here too. Even though it's about like, leaving quote unquote, finger sticks, you're never going to leave finger sticks by the way, you're going to need them. You're gonna test when you're not sure about your CGM. You're gonna test when you're making big decisions. I listen to my daughter's blood sugar looks high on her CGM, and we're gonna make a big Bolus. I said, Look, you gotta test we got to know this numbers, right? We can't just start throwing insulin in here. And you're actually 40 points lower than this, or whatever.
Jennifer Smith, CDE 37:23
And I think it's also really important to acknowledge what you know about how you feel around certain blood sugars. Because again, technology. It's wonderful. And it's so much better than it was years ago. But it may still not be accurate at certain points. So always those finger sticks are important to continue to use. Because if your symptoms or how you're feeling doesn't go with what your CGM is reading, I guarantee a finger stick isn't gonna lie to you not unless you still have like, apple juice on your fingers.
Scott Benner 37:58
I was gonna say and I didn't get to it just an accurate meter, just a blood glucose meter. Yes, they're not all the same. They don't all work as well. Don't just take the one that doctor handed you from the drawer, do a tiny bit of research use the one that I that advertises here because that's the one we use and it's amazing and, you know, like or do what you can do your own research and find out I will throw out a little story here. Because I did spend the weekend with my college age daughter, which I haven't done in a while as a visitor at school. Second night she was with me. We replaced her CGM. Okay. So at five o'clock at night, I said, Hey, your Dexcom is going to expire one in the morning. You should switch it now. It's before we're going to eat dinner. We'll get it back online. It will have it we can do some finger sticks through dinner. And then it'll be rolling and working well by the time we go to sleep, because it does take a little while for some people where to look right. You know, she does. I don't want to do that right now. So then when do we change her CGM? 10 o'clock 11 o'clock, you know, like, oh, so then it's done. So then it's wonky for the first couple hours. And for Arden, if her Dexcom is wonky, it's wonky low when she first puts it on minus two. Okay. So like, I mean, it'll be like you're 42. And she's 10. Like that kind of thing. Yep. So there's a lot of consternation in what you should do. I'm a fan of letting it be on for a little while and calibrating it to help it get along a little more. But now we're asleep. And it's like BP people. All I could think was I told I know I said this. Nobody listens to me. But that's fine. And I'm like, and I know she's not that low like and but it's worrying. So now she's, she's asleep. And I get up and I'm checking her blood sugar and she wakes up. She's like, What are you doing? I'm like, your CGM is going off. She goes, I'm fine. It's like okay, so I tested her and she was 130. And I was like, okay, so she's right. And I did a calibration and it came together. Other pretty quickly. And that was it. Having said that, we could have done that at five o'clock. There. So there is a way to time, your technology. Now the new g7 is going to have a shorter warmup period, which will help overlapping you'll be able to soak your sensor, which I'm not going to bother explaining here. But yeah, but as the technology gets better, so should those things. But that is not to say it's not, like hands down. The most valuable thing that's happened to people who have any kind of diabetes. Since I've since I've been aware of diabetes, so absolutely. Okay. All right, Jenny. Now we got our CGM. We're using a pump. We're looking online. And we're like, see, this isn't that the doctor is not gonna go you know, you got to do. That's not gonna happen now because this stuff's also new. Maybe Maybe you're really in tune doctor might say, why don't you get an algorithm? But for the most part, I don't think I think that's the thing you're gonna figure out on your own a little bit. So all this stuff we're talking about about, you know, the Bayes will be incorrect. And you might need a Temp Basal here. You might need an extended Bolus for fat you might need all this. There are pumps that make those decisions autonomously. Yeah, you have to be wearing at this time, you have to be wearing index calm, because it works with that correct. But
Jennifer Smith, CDE 41:19
or med tronics. Um, CGM? Yeah. Because they're their system also works with their pump.
Scott Benner 41:25
Yes. So there's a Medtronic version of this. There's a tandem version of this. There's an Omnipod version of this. All their algorithms are proprietary, they work slightly differently, but long, and the short of it is they're going to give you insulin when you need insulin, and they're going to take insulin away when you don't need it. They're going to endeavor to stop you from getting low, and endeavor to stop you from getting too high. You
Jennifer Smith, CDE 41:48
still know how they do that it was with targets. Yes. Right, right, specific targets in each of the different pump systems. Medtronic newest one was just approved, which is really nice. But they all have specific targets. So how that algorithm works is based on when and how to give you more or less based on a target and based on what the system is projecting off of your current CGM trend. So it's a very interesting, like the algorithms don't just willy nilly deliver or take.
Scott Benner 42:24
Like, I think maybe now more,
Jennifer Smith, CDE 42:26
right? Yeah, exactly. There's a map to the algorithm right
Scott Benner 42:29
Gremlin inside of your pub flipping a coin going, Oh, my God heads. Let's do it. So but it's it's it's stunning. Now there's another version. There's a number of other versions there are Do It Yourself versions. There's Android APs. There's loop. I think, Jenny, you loop. Right. I do. I think you would
Jennifer Smith, CDE 42:48
have been looping for five and a half years.
Scott Benner 42:52
And Arden has been doing it. I think since 2019. Maybe? So yeah. And you're Arden's using loop three, as am I and you just switched to it as well. So like, they're all just different versions of an algorithm making decisions about insulin based on your CGM trend. That's Yep. They're astonishing. They work incredibly well. They are not magic. I know in all settings, all knowing how to Bolus for certain foods, understanding the impacts of things, your digestion, your hydration, like all the things that are important about MDI are the same things that are important about pumping are the same things that are important about using an algorithm.
Jennifer Smith, CDE 43:38
And you made I know, people can't see you, but you were very in a line going from MDI, to pumping to algorithm. And I think that's, it's a really important piece. For those who are listening to understand if you're kind of listening to this, because these are not pieces in your life already. Right, and you want to get an idea. There is 100%, I'd say 1,000% value in learning on MDI. And then moving to a conventional pump, that does not do anything for you, meaning it does not use an algorithm. There's absolute value in that, you know, we talked about testing, and evaluating settings, and learning about all the variables, food and activity and everything and how to adjust your pump or your insulin doses to accommodate for those variables. I think as you mentioned, when you said you owe your pumps, like, hey, let's start on algorithms. I can't go as deep as you. So it's a totally different doctor, right? But in that sense, there are I think more doctors today who are thinking algorithm, but in my personal and professional In all opinion, I think some of them are thinking that too fast. Okay? They are they are moving somebody to, hey, you're MDI, let's move to this algorithm driven system, whatever the system is, whether it's Omnipod, five, or tandem or Medtronic. There is, there's a missing piece in the middle there, that if for some reason, and we talked about CGM is potentially not being always accurate or technology failing. If your pump fails in its algorithmic dosing, and you have nothing to step back to, you're at a loss. And it's important to understand that, you know, so I can't emphasize.
Scott Benner 45:42
It's incredibly important. Jenny's been talking to me about this privately for years. Honestly, she's like, people can't just be put on the machine, the machine does the whole thing. And they don't understand why it's happening. Because, you know, the general argument is, what if the machine stops working? I don't even think that's the need for that. No, I think the need is, is that this is a thing you have to understand. Like it, no matter what none of this machine stuff is at the point where you don't need to know how to how it works. It's not AI, it's not even a computer like you know, used to have to know how to fix your computer, because it would break all the time. Nowadays, you buy a Mac, it'll just do the thing you want it to do, you'll never have to touch it, and it'll die. At the end, you're like, Oh, my Mac doesn't work anymore, you get another one. And you don't need to understand how a computer works. To use a computer. You need to understand how diabetes works. To have diabetes, I don't care what version of care you're using, I don't care what the next one is. Now, if someone magically comes up with something one day, where it just works, no matter what, like a, like a laptop from Apple, okay, then then okay, then God bless. If you want to skip it, then skip it. But I'm still gonna say, that isn't happening anytime soon. Because of not just the things we've mentioned today. You know, your insulin pump site might not work on time, like your CGM might not be right right away, like all the other things, it just not happening anytime soon. So you don't want. The worst thing I can imagine is that you put an algorithm on a nine year old who it works for. And then five years later, the kid hits like puberty hard or something and you have no idea, like the algorithms doesn't know you just became a completely different person, you're gonna have to change your settings to make that work, right. And that takes experience. And if you I think if you ever find yourself listening to Jenny and I talking and thinking, How come whenever something comes up, they just fill the next space with something valuable. It's because Jenny's been living with diabetes for over 30 years. And I've been staring at my daughter for 15 years watching her have diabetes. And I have a never ending supply of experiences and answers in my head because I learned through them. Yes, that's why and that's why you? Yeah, like you didn't go to like diabetes University where they told you something secret that they don't tell everybody else, right?
Jennifer Smith, CDE 48:14
No, no, no, not at all. I mean, I have valuable behind the scenes, like information about disease states and those types of things from a medical knowledge base. Absolutely. And understanding them helps me to understand some of the navigation of that with diabetes, but the lived experience and the work that I get to do with so many people, that's the valley that you can't teach that. In a university, you you can't teach, there's no degree and diet.
Scott Benner 48:47
And for your situation, you've been helping people for so long it professionally. I tell people all the time, like, it's, it's gonna sound self serving, but it's not like it's that I was able to get advertisers for the show. So I get to turn the show into a job so that I could put this much effort into it. Because I learned every day I talked to people, like you'll hear me say like, Oh, I was talking to a guy the other day, he said something about this. That's me. hearing something I'd never heard before and right and retaining it and being able to apply it to a situation go, oh, you know where that'll help here. And then you get to keep expanding those conversations. I'm going to get to something here and you get to keep expanding those conversations till they help other things. We did fibroid episodes. Now we hear from people are like, Oh my God, my life is different. Because I got my thyroid managed well, I'm getting a lot of my I didn't realize about my iron and my ferritin like a lot of women especially are getting back to me like they're feeling so much better, because it's something they heard on the podcast. They heard it on the podcast, because I was able to focus on this because this is what I think about And now and now it's coming to digestion. And that because we had to figure out a problem with my daughter's digestion. And then we shared Get on the podcast now I've seen that help other people. That goes for little things about diabetes too. Yes, that's how this stuff spreads. This is a repository of information, but you're gonna build that in your own mind. Correct. But not if somebody slaps an algorithm on you and tells you don't worry about the thing. I'll take care of it.
Jennifer Smith, CDE 50:18
Right? Because it one that's such a, that's such a big thing that I hear well, shouldn't it be helping me with this shouldn't be doing this shouldn't? The one word I hate is learned, shouldn't have learned that I don't need this much insulin at two o'clock in the morning. Nope, your system isn't learning. I promise you it's not learning. doesn't keep track of two o'clock in the morning, gosh, I gotta give less insulin for this person. It's not that's it's not smart.
Scott Benner 50:44
Now. And Jenny, do you know oddly enough, as we make this episode, I put up an episode today called Rise of the Machines, where a guy comes on to talk about his Android APS system and how it he does believe it's going to learn in the future. Correct is so exciting, but not now. Like, what's one of his examples? He said, location services. So if you say I'm having pizza, and it realizes you're at Domino's, okay, and you have an experience with insulin, at some day, it will remember that experience. Yeah, if you go to a different pizza place and have a different experience. It'll remember that if you go to a pizza place, it'll remember that if you head back to Domino's, it's gonna go Oh, we're back at Domino's. This. That's not happening right now.
Jennifer Smith, CDE 51:33
No, in fact, there is there are some. There are some apps that actually you can track that way. Like you can take a photo of something and tap the location indicator. And the next time you come back to that location, you'll be able to see what your dosing looked like what your CGM trend looked like. So you can learn from Bob's pizzas, Friday night, last week to this Friday night, maybe I should change my strategy, it looked like this. And I want to improve this right or do it differently. But those they need to be married right into the pump so that not only do you have Okay, now I'm at Bob's pizza, this is what I had. And hey, let's the pump then can acknowledge and I'm going to do something different for Jenny.
Scott Benner 52:17
But for that happening just automatically, that's not here yet. 2023 on the pod five doesn't do that. Tandem T slim doesn't do that the control IQ doesn't do that. The mechanic doesn't do that. Now, it may have happened one day. Sure. But the other I think the other thing is, I know you want your days to be easy, and they can be they can be much easier than they are now they can be more your intuition can come into play as you grow. But this is a lifelong thing. And what you want is you want to get to the point where I saw Arden get into this weekend, where we sat down to this meal, there were 16 different things. And she just looked at it and picked up her phone and went and pushed the button. Yeah. And I was like, how much did she give? She was I don't know, I told it was like 85 carbs. And it was and she and I was like, okay, and then she was okay. And it was okay, just looked at a table at a restaurant. And she's like, I think about this much. And and that's boy, forget this podcast and everything else. It's that's where you want to get to where just where you wake up at two in the morning, you see a high blood sugar and you go, Oh, I know what this is. And that does come it really does come. So anyway. But you're gonna transition along, by the way, I think algorithms are amazing. And
Jennifer Smith, CDE 53:42
yes, they are. Absolutely I I love my algorithm. Absolutely. But I've also learned to work with it. And I've learned what it can do and what I still need to tell it to do. I think that's the big thing about algorithms is knowing that you still have a fair amount of action to put in to it so that the algorithm can work with you.
Scott Benner 54:04
Yeah, yeah, I wouldn't want anybody to think like, oh, you're using a do it yourself loop. It's magical over the other comp there. It all is about the same. Like they all need your help. They all need your intuition. They all need your knowledge. There's nothing if you think you're going to just put a loop on or on the pod five, and it's just going to be perfect. Like you don't have to do anything. Like that's not going to be the case. No. Yeah. So but don't be afraid. No, like I I'll say something here on the hall, save myself Saturday, make a beat and make myself sad. Yesterday was my friend Mike's would have been my friend Mike's birthday. And I don't want to bring all this down. But Mike had diabetes. Type one when we were teenagers. He's not with us any longer. I believe that one of the reasons Mike's not with us any longer is because Jenny alluded earlier that I was stepping along with my hands while I was talking about things like Mike Never came along. He just somebody gave him regular and mph. And he used it long, long after he should have been, you know, didn't have updated meters and didn't you know, he didn't do the little things that you do to come along. I mean, I guess what I'm saying is you don't want to be managing your diabetes like it was 10 years ago. Right? I don't think so.
Jennifer Smith, CDE 55:25
I think you're also bringing something in here. That's really important to consider, because you've, you've talked about, you know, practitioners bringing up hey, why don't you try a CGM? Hey, why don't you try a pump? If, if you're the one always going to your doctor asking for what's new. I don't know. I you know, and your doctor is very willing and can talk about it then with you. Maybe they didn't bring it up. But they're very, they're knowledgeable about it. Once you do get on it fine. But if this is someone who's never really brought it up, and kind of like, shrugs their shoulder and like, sure you could try it, whatever you may need kind of like your friend maybe didn't have a doctor who was keeping up with what could have been better for him.
Scott Benner 56:10
Yeah, yeah. Yeah, you don't you have to take this as a, I don't know, if you want to call it a disease or like, some people don't like that word. But this is a way of living, that it begs you to be involved in it? Yes. Like, it just, it just really does. You have to be aware, you have to take some time to learn what is happening with technology, what's happening with insolence, you know, and you need to move along with it. Because if you look back 50 years, I still interview people who are like in their 70s and have had diabetes forever. And they don't even understand why they're alive. Like, like, you don't want your life to be a coin flip. You don't I mean, like there are things you can do to to, to give yourself better health outcomes. And those health outcomes are not just health outcomes, their quality of life, they're your they're your psychological state of being like there's so much good that comes from just understanding. I know that sounds silly, but how to set your basil right? And make sure your correction factors, right. And you know how to cover the foods you eat?
Jennifer Smith, CDE 57:16
Absolutely, I think and on a bigger scale. We're also we're all supposed to be a participant in our life, right? health in general, you may have been given good health to begin with, but you're the keeper of that health. Right? It's just like, you're the keeper of the car. If you continue to let the salt buildup on you never wash it off, you're gonna have a rusty car. Well, you're your body's the same way, right? You're the keeper of your health, you got to do things to maintain your health, diabetes, it stepped up a level it is
Scott Benner 57:50
absolutely. And so prepare to transition by getting as much good information as you can, but then at some point, just have to do it. You have to just dive in and do it and then learn a new thing. And then once then you'll be surprised at what else comes from that. And anyway, listen, it's also not to say that you couldn't get an algorithm pump right now and teach yourself backwards. I actually think you can. Sure. I think some people have a harder time with that than others. And I don't want you to be in a position where you're lost and something's happening. And you don't understand why because it won't be any different than a person that gets over Basal on MDI and thinks they're doing okay, but it's not really covering their meals well, right, you know, and then doesn't get hungry one day, and then it's up low all afternoon doesn't understand what happened. Like diabetes. There's no reason that if, if you have an if you have enough information and understanding diabetes doesn't have to happen to you. And I think that's maybe the most important part like I would if it feels like it's happening to you, instead of you are doing something and then something's happening. I think you have to have to look and get a deeper understanding, because it shouldn't just be happening to you. That's all. Okay. Awesome. Thank you Jerry.
Huge thanks to Jenny for helping me once again on the Juicebox Podcast, you can learn more about what she does for a living at integrated diabetes.com Jenny might be able to help you. Thank you very much cozy Earth for sponsoring this episode of The Juicebox Podcast get 35% off your entire order at cozy earth.com By using the offer code juice box at checkout. And don't miss the rest of the diabetes Pro Tip series and the other series within the podcast. If you give me a little gifts, give me two more minutes of your time after the music and I'm gonna tell you a little more about this series and the others But first tips from other listeners. I want to thank everyone who left their tips for this episode on the private Facebook group Juicebox Podcast type one diabetes and the people who left their tips on the public group bold with insulin. This first one is for going from pumping the algorithm test your basil and your ratios before you move to an algorithm. The first few weeks may be frustrating, don't give up. Reach out to people online for advice. They probably have been doing it longer than you. This person leaves a little bit of advice from going from MDI to pump says the first night they kept getting low and didn't remember that they could turn their basil down. We talked about this in the episode having access to your Basal insulin. Next one says Oh, I love this one. Listen to the diabetes Pro Tip series from the Juicebox Podcast Take notes. Here's another one from this person. Some sites have dramatically different absorption rates. We talked about that in the podcast. Here's one for Dexcom. Learn to look at the dots instead of just the number in the arrows. This person says when you're going from just having a meter to a CGM. Remember the CGM is just one of the tools in your arsenal, it's not a full replacement for a blood glucose meter. Use both tools effectively. Don't get overwhelmed. They are just numbers and data. It's not a grade for you. It's good advice to this person says no matter what you're doing, whether you're changing from MDI, to pumping pumping to algorithms, your ratios are likely going to change. And that takes time to figure out. This person says not all algorithms are the same. So make sure you understand which one you have and how it works. Their example here is if you're having trouble with a T slim product, don't use someone's advice from the pod five, it won't be the same. Don't assume that your CGM is always correct calibrated if symptoms aren't matching the number, use finger sticks to make sure other person preaching patience, and says not to make perfection your goal, just shoot for shorter peaks, and more shallow valleys in the beginning and over time, your skills will get better. And those peaks and valleys will flatten out. This person says be prepared when your technology doesn't work. And please don't expect perfection. Another person basil testing, there's a great episode about Basal testing in the Pro Tip series. Here's one that just says don't give up. I like that one. I like this one here. Don't use too many new or different foods when you're trying to figure something out. So stick to meals that you are good at bolusing for that way you remove variables, right, like you know, on MDI knew how to cover this food. So I'm doing the same thing on pumping, what's not working, then you can look at your settings and see what's different. I'd say that's a great one. I like that a lot. Educate yourself on how your pump works. Don't just trust that your rep set it up correctly. It's a lot of settings in there. It's a good one. We were used to coasting high no matter what this is an MDI, person to pumping. And we rounded up way too much on our carbs. When we switch to a pump, it took a few weeks of lows to get out of that habit and trust that the pump knew what it was doing. Interesting. So if the settings are good on the pump, I see what they're saying their settings on MDI weren't great. So they were always just, you know, doing more. But when the pump was set up, well, they didn't need to do that anymore. It's interesting. That's a good one. Here's a great one. Don't just put in settings into your palm, write them down somewhere. If something happens to the pump, you need to have them to put back into a new one. And keep a pen or needles handy in case you need to do manual injections. Even on a pump, you might have to do that sometime. That's very good to your settings in a manual pump may not work in your algorithm. This person talking about a CGM says when you start a sensor start at a time of day when you haven't eaten for a couple of hours. And you're not going to eat for a couple more hours if you can. Evening is good, especially for kids in school so the sensor doesn't run out at school. Oh, that's a good one. So he like you don't want to like put it on. I think what they're saying is you don't want to put it on at nine o'clock in the morning on Saturday. Because then at nine o'clock in the morning, you know, on a weekday it might run out. That's a good one. Don't feel bad about removing a sensor if something's wrong, whether it's causing pain or discomfort because you can always call the company and they'll respond with a replacement. You may have heard leaders or readers, that's not always the case. This person says if you haven't heard that phrase, you will eventually take pictures of your CGM sensor codes and transmitters put the expiration date into your calendar with a reminder and that way it won't sneak up on you. Here's one for going from MDI to pumping make sure the correct factor is calculated using the number, the pump shoots for not the one you were shooting for on MDI. Interesting. So what she's saying I think is if the pump gets set up in the target is 100. But when you are MDI the target was, then your correction factor won't be correct. Interesting. This is funny, I can't read you the whole thing, but it says, eventually, something's gonna go wrong. And your tech savvy husband is somehow going to push the wrong button and deactivate everything. I don't think that's as much advice as somebody who wanted to tell a funny story. Going from a blood glucose meter to a CGM. Don't look at the thing every five minutes for me that led to me overreacting to blood sugars, that may not have warranted a reaction at all. Set your alarms at a useful level. This one's terrific the person who sent this one and use that to guide your decisions rather than checking constantly on CGM. I'm a big believer in this by the way, if it doesn't beep, I don't look, there's a person here echoing this sentiment that blood sugars can be fluid, and that it's possible you can overreact and be the reason it's jumping up and down. I think that's worth repeating actually. When you're going from MDI to pumping, you don't need to wait to do a correction Bolus, make use of the insulin onboard information that the pump has great one, that's a great little tip. There's a comment here with a ton of information for the Omni pod five, I'll tell you there's actually an omni pod five Pro Tip series. Definitely listen to that before you go to Omni pod five. But I do want to add a little bit here from this post. Fluid insulin delivery, like an algorithm has to do suspending and increases and decreases and that demands a different approach than a static Basal. So in a regular manual pump, where you might just say, um, one util an hour all day long. You're making a lot of adjustments throughout the day that you don't realize, because there are times you don't need that insulin at a unit an hour might need it more may need it less. That's why the initial settings on these are so important and you kind of stepping back and watching it work for a while to see where your settings may need to be adjusted. Or maybe the way you use your insulin needs to be adjusted Pre-Bolus etc. This person says that a pump was not a cure all for their problems. And they found it very deflating when they went from MDI dual pump and it just didn't make everything better. That's important, Jenny and I definitely went over that in this episode. But keep in mind, this person says here that your doctor's office might say we don't give a pump till one year or you can have a pump till after you've been on MDI for six months or something. That'll sound like a rule to you when they say it. But that's not really a rule. You can, you can push. This is a reiteration of something we heard before. But when you're going from just a blood glucose meter to a CGM, you might want to take some time to just absorb everything. You don't want to just jump in and start tinkering right away before you know what it is you're doing. You know why you turning this dial on that dial really kind of lived through it for days, maybe weeks, even before you just say, alright, I see a trend here. I know what's happening. This is an interesting one. This is for somebody going from MDI to pumping. They don't want you to forget the tricks, you know, brain like if you see a blood sugar, and it's kind of stuck and it won't move and back on MDI, you want to inject it in a unit, there's no reason why you can't give a unit with the pump. Just because the pump says, Hey, there's still insulin onboard, it doesn't mean that that insulin was calculated correctly, and is really about to make an impact. I think they're saying trust your gut. This one's a little long, but the person says everyone's experience is going to be different. So roll up your sleeves, go into it with an open mind and be ready to dig in and do some problem solving. And don't forget to listen to the podcast, they go on to say when going from MDI to a pump, you really have no idea what to expect, you can only kind of hope that you start out with great settings. But that may not be the case. So many people end up having a poor experience when they switch and then they share that online. And then this person was like scared. That's what was gonna happen to them. But then that wasn't what happened at all.
It was incredibly easy, she said, and his numbers got much better very quickly. So I think the I think the message here is, sometimes people just share bad news online, doesn't mean everything's bad news. Here's a little tip. A pump company puts their pump through the FDA for approval, and they choose a couple of insolence to use in the pump. Those insulins are then approved in the pump. It doesn't always mean that the ones that aren't improved in the pump won't work in the pump. It just means they didn't put it through FDA testing. I want to thank everybody who share those tips and remind you that those people exist in the private Facebook group for the Juicebox Podcast. There are so many other management based series within the podcast. You're listening, of course right now to the diabetes Pro Tip series diabetes Pro, tip.com, juicebox, podcast.com, and in your audio app, but there's also the defining diabetes series, diabetes variables defining thyroid, bold beginnings, ask Scott and Jenny. And we have collections of episodes about algorithm pumping, which we talked about a little bit today, you can find out way more in the algorithm pumping episodes. There's the after dark series where we talk about all the things that people don't usually talk about about diabetes, how we eat mental wellness, there's so much to choose from. And if you happen to know somebody with type two, there's a brand new type two diabetes series for people with type two or pre diabetes. Check them out at juicebox podcast.com. Here's a little feedback from other Juicebox Podcast listeners. After devouring the Pro Tip series, I got my daily average down by 30 points. And I'm excited to continue learning from this all in one resource. If you're struggling with insulin, this is the place to figure it all out. I am so thankful that a friend recommended the Juicebox Podcast to me, and I wish that I would have found it at the beginning of my journey. I have been binge listening since I found this podcast. My son and husband both have type one man, I wish I had this when my son was still living at home. I'm learning and sharing how we're going to get our agencies lower. I've had type one diabetes for 20 years, and it was never well controlled until I started listening to the Juicebox Podcast. I've become bold with insulin. And this podcast is unlocked the solutions to so many issues I've struggled with for years. I can read you these reviews all day. But I would prefer to stop because it seems it's tricky to do this right? I just want you to go listen to the Pro Tip series, find the defining diabetes. If you're new, go check out bold beginnings. All of the information that you could possibly want and need about managing your insulin is in the Juicebox Podcast. Subscribe now in a podcast player like Apple podcasts or Spotify, Amazon music or wherever you get your audio. And don't forget to check out the private Facebook group, which is also free Juicebox Podcast type one diabetes 37,000 members and it grows by hundreds of people every week. What a resource. Please don't miss out on this community.
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#681 Defining Diabetes: Types of Diabetes
Scott and Jenny Smith define diabetes terms
Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain the different types of diabetes..
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends, and welcome to episode 681 of the Juicebox Podcast.
Today, I'm back with Jenny Smith for another episode of defining diabetes. And today Jenny and I are going to define all of the different types of diabetes. And there's more than you might think there's type one and type two. Sure. But what about type one and a half? Is there a type three, a type eight, we're gonna find out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, the T one D exchange is looking for your thoughts. Those thoughts come in the form of answers to survey questions that you can find at T one D exchange.org. Forward slash juicebox. completely anonymous, HIPAA compliant, easy to do, helps people with type one, t one D exchange.org, forward slash juicebox take you less time that it takes for you to figure out that Wordle. And you'll help somebody that word doesn't help anybody.
By the way, I got the word of last night and three, I was pretty proud of myself. I digress to say this. This episode of The Juicebox Podcast is sponsored by us med. Get your diabetes supplies from us med. I'm going to in this episode of the podcast when I get to the US med add, I'm going to read something that a listener sent me for now know this white glove treatment, always 90 days worth of supplies, they have fast free shipping, you get it every time us med check them out at us med.com forward slash use box or an 888-721-1514 at that link. And that number. You get yourself a free benefits check and get started today with us, Matt. Hey, Johnny, how are you?
Jennifer Smith, CDE 2:22
I'm fine. How are you? Scott? Good,
Scott Benner 2:24
good. Good. I want to do a defining episode today about the types of diabetes. Oh, fancy. I was surprised by this. So I mean, first, let's just get the one out of the way that I think will be easiest forest, type one diabetes. What is it?
Jennifer Smith, CDE 2:43
Essentially, conditioning the body that means that your pancreas is no longer producing insulin from the beta cells, right? I mean, there's been destruction of those beta cells to the effect that you now have virtually no or have no insulin production left. So
Scott Benner 3:04
you might also hear it called juvenile diabetes, insulin dependent diabetes. I think it's important to say it's a chronic condition. There's no known cure for it. And it's autoimmune. Correct, right. So this happened, because, you know, go listen to another episode about there's a defining diabetes episode about antibodies, that one listen to that one, if you want to know more about it, but the bare bones idea is you didn't do anything to get diabetes, your body just got a little confused, took off after your beta cells instead of the flu or coxsackievirus or whatever else you had that your body should have been doing that day. And now you do not have functioning beta cells in your pancreas. Correct. Alright, so there's not going to be much to this, obviously. But we want to put them all in here together. So type one diabetes, that's what it is. Boom. Now, you would think obviously, we're gonna go to type two diabetes, because you all know how to count you think one and then two comes after but no, there's that would be too easy. There's a type 1.5 diabetes. That's Lada. Right.
Jennifer Smith, CDE 4:15
That's Lada. And in fact, I've I mean, I think more lately, it's definitely been referred to as lotta latent autoimmune diabetes of the adult, right. I have heard the term one and a half a lot less often, which I think is actually not a bad thing. Because if you consider the true nature of that type of diabetes, it tends to be a lot more similar and is often classified with type one, but happens truly in adults, and is for most people a slower progression to diagnosis. Okay. So still is an autoimmune disorder or you know, an autoimmune condition where the body has destroyed beta cells. In adult, it seems to be a slower progressive destruction. So again, a sort of a slower diagnostic. In fact, I've had a number of people that I've worked with who've actually been misdiagnosed, because it was so slowly progressing, that they were just initially diagnosed type two, and they really weren't.
Scott Benner 5:27
Yeah, I hear about that a lot. Actually. The type does lotta have characteristics of both type one and type two? Was it somebody being like, cute when they named it? Like, it's almost type two and almost type one, and it's in the middle? Nothing like that.
Jennifer Smith, CDE 5:41
That really, I mean, again, there are there are characteristics I think in people who have either type one or type two, that could cross and look similar to the other type of diabetes being the two main types, type one and type two, right? And then you could have some insulin resistance in type one, which typically isn't the reason that type or it isn't the reason that type one is there, right? But they could have some resistance, which is much more classified with type two. So somebody with LADA could certainly have some of both of those pieces, but Lada will be diagnosed because there will be antibodies present. Okay.
Scott Benner 6:21
So if I want to think about that in a really basic way, it's a very slow onset type one diabetes that only happens in adults.
Jennifer Smith, CDE 6:30
Right? A B would not be a child and be diagnosed with ladder
Scott Benner 6:33
because of the super slow onset. People can confuse it for type two diabetes.
Jennifer Smith, CDE 6:38
In a general Yes, in a very easy way to see it. Yes. Yeah.
Scott Benner 6:42
Because it's you're still getting work out of your pancreas. But it's not shutting off kind of abruptly, like you see with type one. Correct, right. So when you're saying a slow onset, it's not like a honeymoon. It's, it's much more protracted than that.
Jennifer Smith, CDE 6:59
It is, in fact, people with people diagnosed with Leida Lada often have once they actually get diagnosed and have the right tools to manage insulin being major one of them right, they often then may have a longer honeymoon after they're actually diagnosed. And in fact, people with LADA also often have more beta cell preservation. Longer term, they still obviously have to use insulin, but their insulin doses may look very small, comparative to others who have had type one for a while and their same age and same body type and same activity level and whatnot. So there are you know, defining differences between type one and Lada diagnosis.
Scott Benner 7:55
I find it interesting when you Google something to see what else people ask about. Yeah,
Jennifer Smith, CDE 8:01
I'd be curious what did you Google? Well, I
Scott Benner 8:03
just definition type 1.5 diabetes. Because you mean you know you're gonna know way more about this stuff than I am. So I wanted to I wanted to be ready a little bit. People listening are like Oh, thanks.
Jennifer Smith, CDE 8:16
You wanted to put on your your graduation cap.
Scott Benner 8:19
I didn't want to do it. I didn't want to do it. A lot of people do and on podcasts and just philosophize out loud about things they think they heard one time so but I do want you to have a little bit of that because I think that that is how people start with Oh, I heard this or I thought that but so other things people ask about Latos what is the difference between type one and a lotta? How can you tell if you have Lada? What do you consider Lada? Does lotta diabetes, shorten your life? Oh, that's sad. Let me get some insulin should be fine, right? Correct. Shouldn't be shortened anything. But anyway, like not to even Delve. Although what's the difference between Let me see how it talks about the difference?
Jennifer Smith, CDE 9:01
I mean, I'm curious and who defined it would be another good and well, I guess in terms of source
Scott Benner 9:05
Yeah. So you I mean, you did a great job. This one comes to it goes to beyond type one.org. As a form of type one diabetes a lot is the result of your immune system attacking the beta cells in your pancreas to produce insulin. The only difference is that the attack is slower, which means so you don't need these people. You got Johnny, it's all good.
Jennifer Smith, CDE 9:25
But I'm glad that I'm in agreeance with another source of good information like beyond type one, let's
Scott Benner 9:32
say I don't even know what we would have done right now if I would have read something that completely contradicted what you said. I would have been like, Jenny's fired and then you as I was going away, you'd be like you don't even pay me and then that would have been the anyway. Alright. So now I got into this weird space. I know you think now we're definitely going to do type two. Not quite yet. Hold on. Where I saw someone online and we'll talk about this maybe at the end of this. I just put up a post and I was like, guys, hey, Listen, what else belongs in the defining diabetes series. And this person says, I keep hearing about type three diabetes. So I was like, alright, so I googled, and I got type three diabetes is a proposed term to describe the interlinked association between type one type two, and Alzheimer's disease. Yes, the term is used to look into potential triggers of Alzheimer's disease in people with diabetes,
Jennifer Smith, CDE 10:28
linked to insulin resistance, and insulin resistance and an insulin. Kept to remember that insulin like growth factor is what they're looking at insulin resistance specifically in the brain. And what they're, they've also often linked to type two and Alzheimer's disease, which is sort of what triggered this type three name overall. So there's a lot of medical research about blood sugar, and brain health. It's, it's amazing if you look into it, not only not only Alzheimer's, but Parkinson's and many of those neurological conditions disorders, there, there are a lot of big links with blood sugar.
Scott Benner 11:21
So then I went down a rat, another rabbit hole, oh, my god, what is type three C diabetes. And I was like, Where will this end? And then I kept googling. There's a type four, and a five and a six, and a seven, and an eight. And I stopped at eight because I got freaked out.
Jennifer Smith, CDE 11:43
And I, I mean, those are very specific to other system issues in the body. They're not, they're not definitely like type one type two gestational, they're not Lada they're not in that same realm of categorization. I mean, even when we were defining type one, you know, type one in another, and I'm sure it has some type of letter categorization to it. But I've worked with people who have actually had pancreatic cancer, and pancreatic, you know, removal from their body, which means that there's not one autoimmune reason that they are deficient in insulin or beta cells. They just don't have the gland anymore that makes it
Scott Benner 12:30
right. Like, what did they just when you have a penk Ritek? When they take out your pancreas for reasons that are like another thing? Do you? Are you assigned a different type? Or are you just type one that
Jennifer Smith, CDE 12:44
I believe that if it's a pancreatic cancer that falls into the type three C categorization. And I know that I've worked with only two people who have actually had cystic fibrosis. And as a result also had what we just treated the same as what we would do with type one diabetes, right? From a standpoint of management, its insulin management, both of them were on pumps, you know, so, but that's not true. Type One, there's another body condition there. Yeah. Because
Scott Benner 13:26
the auto immune didn't cause it. You're right, you're gonna live like a type one after that. But you didn't technically ever have type one diabetes. And that I've interviewed a number of people who have had their pancreas removed for other reasons. And they are they do want that distinction. The people I've spoken to so far, you know, I've also heard people who are well welcomed into the type one community and there have been times where people have said, like, you don't have type one diabetes, like you don't belong here. I don't know. I don't believe in that. That's no good for me. If you're using insulin, you need this help. And that's that. So anyway, let's just look for a second type for diabetes is a proposed term for diabetes caused by insulin resistance and older people who don't have overweight who don't have overweight or obesity. This is a 2015 study. So I think they just as they're studying more and more things, they just keep applying this because now when you get to type five, it's called moody five.
Jennifer Smith, CDE 14:27
Mo D Why is is mono
Scott Benner 14:30
moody. Excuse me? Yes. Yes. I'm sorry. I put one too many O's in my that's mature onset diabetes. Wait, why is my phone making noise Jennifer? I don't know. Somebody wants to reach you. I'm gonna curse here. This can Walgreens okay. You leave a prescription sit at Walgreens for five seconds. And they call you they are up your ass. It's here and get it. It's yeah, I'm like, if I know thank you be there. All right. Have it calmed down now I won't stop now it's good telling me when the pharmacist takes lunch is it noon
Jennifer Smith, CDE 15:11
and they take an hour lunch at least they do at my Walgreens well God
Scott Benner 15:14
bless that's fine but I don't need to hear about it on the machine every time they call like this happened yesterday.
Jennifer Smith, CDE 15:21
See they don't call me they send me a text message well I'm gonna behind don't have to hear anybody if you're
Scott Benner 15:26
listening to Walgreens you screwed yourself because I'm gonna opt out of this you know and I do find it goodbye she goes at the end goodbye goodbye podcast
Jennifer Smith, CDE 15:36
here was very important that she made sure that you know that your prescription is all set. I think
Scott Benner 15:41
it was a computer even Jenny I don't know if it was a heart but okay, so. So Modi is
how about I read some things from the online. I won't tell anybody's name or if I you know if the people are talking about other companies, I certainly won't, won't say them. But here's one. So far one conversation with us med has been infinitely more helpful than every conversation I've ever had with blank blank. Thank you so much for letting me know about us med. Is it possible another person says that it really will be this easy. It's hard to believe when you've had to deal with other companies that make getting your diabetes supplies so difficult. It's hard to believe that anything could be better, but it can be with us med here's what you do. You go to us med.com forward slash juice box get your free benefits check and get started. Don't like the internet. Use a phone 888-721-1514 They accept Medicare nationwide. US med accepts 800 private insurers they have an A plus rating with the Better Business Bureau. They carry everything from your insulin pumps to your diabetes testing supplies and everything in between. They have all the latest CGM Dexcom G six libre two. And they've served over 1 million diabetes customers since 1996. US med is where Arden is going to get on the pod five from us med they want you to get better service and better care than you're accustomed to. US med is proud of their white glove treatment. Give them a chance. Hit the link, call the number 888-721-1514 We're gonna us med.com forward slash juicebox. There are links in the show notes of your podcast player or at juicebox podcast.com. To us Med and all the sponsors. You could even find the T one D exchange there. T one D exchange.org. Forward slash juicebox. Take the survey Dexcom on the pod contour, G voc touched by type one. They're all there. Check them out. Listen, if you have a need for these things, I hope you use my link. That's really it. When you support the sponsors. You're supporting the podcast, I'm not telling you to go buy an insulin pump you don't want. That would be silly. But if you want it on the vaad use my link and one of Dexcom cha cha cha, you know what I mean? A one, two, cha cha three, four, cha cha cha
Jennifer Smith, CDE 18:27
Well, we have time at some point, I will tell you, if I never told you my Walgreens story, I wrote a letter to the head of Walgreens, you
Scott Benner 18:33
wrote a letter to Walgreens several years ago. Let's save that for the end of the year state of the Jenny address.
Jennifer Smith, CDE 18:39
Oh, yeah. That's an interesting story.
Scott Benner 18:43
I want to hear. So is Modi type five. Have you ever heard that?
Jennifer Smith, CDE 18:49
I've not heard Modi called type five. But I wouldn't be surprised if they've defined it within the category of all of the numbers of types of diabetes. I guess I've only really heard it called Modi. Now Modi in and of itself also has many. It's it's very strongly a genetic thing. Right. And it's different from both type one and type two. And the way that it's managed really depends on the type of Modi you have so Modi or type five diabetes. There are there's another little offshoot to that to say you have Modi this Modi you have Modi with these genes you have Modi with these genes, and some of them may be managed. Some of them may be managed with insulin similar to type one. Some of them may be managed with an oral med some of them may be managed with a baseline of a Basal insulin and lifestyle. So there are many depending on what your gene Mody type is, for lack of a better way to describe it. If there is a more standardized, I guess plan for how to help you take control.
Scott Benner 20:09
Well, CHOC Children's Hospital of Philadelphia has Modi as a form of diabetes caused by a mutation of a single gene. The mutation causes pancreatic beta cell to function abnormally, leading to insufficient production of insulin. In some cases, insulin resistance develops. In addition, the pancreas may not produce enough digestive enzymes on this link, they are calling it Modi five. Yeah. And then when interesting when you go back to like, so I just kept googling because I got like, I was like, was there Modi six, and there is Modi six arises from mutations of the gene for the transcription factor referred to as neurogenic. Differentiation one, so then you're that that is what's happening is we're getting into genetics. Now, you're asked, is there a type seven diabetes, a form of diabetes that is characterized by an Auto Sum node dominant mode of inheritance, onset and children or early child adulthood? Usually before 25, a primary defect of insulin secretion and frequent insulin dependence at the beginning of the disease? I'm telling you, I stopped at seven. Because I didn't know where to like, I just didn't know. But let's for fun, let's just change the to eight. And there
Jennifer Smith, CDE 21:26
is there is a registry as well, or I guess it's Chicago, there's a mean place in Chicago, I don't know the name of it. That actually keeps a registry of all people who have actually been tested, and have been given the diagnosis of one of these types of Modi. So it's interesting that it's, it's quite rare, I guess, is the the next thing to bring into this is that don't walk around thinking, Well, I've diabetes, Do I really have like, Modi? Number six? Yeah.
Scott Benner 22:02
No, probably not. Right, or Modi? Eight, which is the slow progressive pancreatic extra and dysfunction, fatty replacement of pancreatic para blah, blah. Who knows there? I'm getting into words. I can't, I can't. But anyway, yeah, I was gonna say the exact same thing, which is why I love you, which is you don't have Modi aid, calm down. And you know, although I might get one email from one person is like, I've got it and then send that email, because I'd love to have you on the show. Because interestingly, I've,
Jennifer Smith, CDE 22:31
I've, again, I've worked with a lot of pregnant or pregnancy, and I've worked with two women who had diagnosed Modi. And it was an it was an interesting, it was an interesting transition through the course of pregnancy, because things changed very differently, comparative to other pregnancies, both type one type two, and even gestational which I have now a lot of knowledge working with things changed very differently along the whole way. So
Scott Benner 23:07
well, then, in your opinion, if someone has type one, and they're treating it like type one, but they have a lot of insulin resistance or something else, at what point do you say can I get the genetic test? And does getting the test help you? Or does it just give you a diagnosis?
Jennifer Smith, CDE 23:22
I don't think you know somebody specifically with a diagnosis of type one who my first question would really be did you have diagnostic testing that showed it was actually auto immune dysfunction, right? Then it is type one, if there is significant insulin resistance, my next step is to say, well, you have Have you ever been tested for PCOS or polycystic ovarian syndrome? Right? Because that is, especially in women. That's a pretty significant reason that many women with type one may actually have some significant resistance over what they think their insulin needs should be based on what their lifestyle kind of looks like.
Scott Benner 24:07
I just wrote down PCOS as another defining idea. Honestly, our conversations today have given me a number of them. Okay, so here's my last question. I heard somebody say this online, and I couldn't tell if they were confused. Or if this was a thing. Can you have type two diabetes and then get type one diabetes? There's no reason you couldn't, right? You couldn't have type two and then have an autoimmune attack? Right? You wouldn't have them both at the same time.
Jennifer Smith, CDE 24:34
No, you wouldn't. And in the grants. Sure. Could that happen? Yeah, I guess. Now, the question also becomes, did the type two ever actually get tested to truly get the correct diagnosis when they were told they were type two. And now things have shifted and they get, let's say, maybe a smarter clinician who's like, Hey, I don't know let's do some testing. And then all of a sudden they end up being Type one there type two, probably did not change from type two into type one. No, no, I mean likely had antibodies all along that initially were never diagnosed the right way. And so they've transitioned to now Yes, being told their type one. But the antibodies have probably always been there.
Scott Benner 25:18
I 100% agree that most people who are going to have go through that process, that's exactly what's going to happen to them. Anecdotally, from what I've heard from so many people, but what I'm saying is, could you not get type two diabetes legitimately have type two diabetes, and then later in life, have an autoimmune attack that gave you type one?
Jennifer Smith, CDE 25:35
You could? I would, I would not leave anything to the realm of not possible in our world.
Scott Benner 25:42
I want to hear from somebody who has had that happen to them. But there is no world where you would. But after that happened to you, would you still now we're just philosophizing, would you still have type two diabetes and type one diabetes,
Jennifer Smith, CDE 25:55
you may still retain some of as you've asked before about resistance, you may still retain some of the characteristics of type two possibly want to hear from those as well. Yeah, that would be that would be certainly interesting. Now, I thought you were going more in the realm of somebody with type two, which I know we haven't defined type two yet. We'll get there. But somebody with type two who let's say, you know, they, they know that they don't have type one, they had a really good doctor, their doctor did do testing and everything. There were no, you know, antibodies or anything there. And they were doing really well with lifestyle and maybe oral medications and whatnot, and now they have to use insulin. That doesn't mean that they're type one. If they just because you have stopped being able to solely make use of oral meds, and you have to start using insulin as a type two. You are still a person with type two diabetes. Yeah. Okay. Why not a person with type one just because you're using insulin,
Scott Benner 26:59
right? You're a type two who uses insulin? Yes. And then a doctor would call it insulin dependent type two, right? Usually, that's how they talked about it. Your chart? Yeah. Okay. All right. So here's the last bit. I get to have more and more people with type two diabetes in the Facebook group, which has been really wonderful because I'm seeing people with type two who use insulin having a ton of success by listening to the podcast. I know people with type two in my own life, some of my own family. I've talked to people for years who have it, I have consistently been stunned by how little people with type two diabetes seem to understand type two diabetes, how little they're taught about it. How often it's enough of a boogeyman in their life that they don't even want to look into it. And, and for me, I just always find it to be sad. I wish if they knew more, they would know more. I personally, I've been dying to have more types who's on the podcast, it's hard to get them to come on. Because really, yeah, it's an I wish they would. Because I would like to, from my perspective, I'd like to have type twos come on and teach me about type two diabetes. I would love to have those conversations just so other people can hear them. But for the purposes of a definition, I want you to tell me what type two diabetes is. Because as I sit here, I wonder if I know. Yeah,
Jennifer Smith, CDE 28:25
I mean, essentially, type two diabetes is not autoimmune. That's one of the first things. It's an impairment really, in the way that body the body is able to use sugar. That's the simple definition of it. Why does that start? There are many thoughts in terms of why, certainly lifestyle is one of the biggest ones that most people hear in terms of, you know, activity level, weight. Genetics can also play a big role in type two diabetes, as well. And why does the body eventually stop using sugar so well, it's on a cellular level, right? It's the way that the body is really responding to the intake of food and breaking it down into your body's main fuel source, which is sugar for most people. The reason for the decline in insulin production happens over a long period of time, which is the reason that many people who are at time of diagnosis with type two, they have often been living with type two diabetes, without realizing that their body was having a problem for somewhere between five to even 10 years. So what ends up happening is that the cells become less able to use sugar. Which what does that do? It leaves more sugar in the bloodstream than should be You there. And the body, body is an amazing thing. It's, it's a self healing machine, it tries really hard to do its best to keep you healthy. So what it does is it sees more sugar, and it tries to ramp up the production of insulin. And for a time, that can work. So people that are having this in this sugar, you know, resistance, essentially, or inaccurate use of sugar, their body is ramping up insulin production enough that their blood tests may or may not show any problems. Which means that again, the doctor doesn't think that that there's a problem there. And then over time, what happens when you overuse anything? It gets tired. Yeah, and so these data cells get worn out from trying and trying and trying and trying to hyper there's that word hyper produce insulin, and they they can't keep up anymore. And so now in terms of testing, fasting testing, or especially Testing, testing, in the post meal time period, those are the points that a doctor could find glucose excursions that are well beyond what a person without any dysfunction in their body should have. So it's kind of a cascade of things that happens over a long period of time. Very unlike diagnosis of type one, which is pretty quick onset for most people. Yeah.
Scott Benner 31:34
We're gonna, I intend to dig into this more throughout the podcast, because in my, in my heart, like, I think, when you have a person with type one diabetes in your life that you're taking care of, it takes a toll on your health, too. And I, I'm trying to think big picture and long term here, but how many people who have young kids with type one right now are going to end up sleep deprived or time deprived and suddenly start ordering out more or cooking from boxes more something like that, and, and maybe they'll end up in a similar situation with type two diabetes down the road, I want them to be aware of it as much as they can. Because that number, like when you hear people talk about how many people have diabetes, there are, and they don't in the world, and they don't distinguish between type one or type two or certain country, the number you always see that's frightening is the Undiagnosed number. Yes, that that expectation of what that number is, is is insane. It really is. And I mean, it is it is type to impact the impact double, once you have it, is it impactful, always with diet, or just sometimes with diet? Like it's not like, like, if you could force everyone with type two diabetes to eat exactly the same way, they wouldn't all have the same outcomes, right?
Jennifer Smith, CDE 32:55
Not necessarily. And I think that goes along with again, where do you catch diagnosis, you know, if the body is then so stressed over trying to do as well as it can for you, for a long time, there, there may have been enough beta cell destruction, that you're never really going to get back to a baseline of no kind of medication, right? some lifestyle changes can last a very long time. But it's it's like anything, it's the sticking to that management plan. And not veering from it. Right. And then I think the other piece that you bring in, in terms of like, knowledge is, the sticking with it is it's a really hard thing, and when you've been sticking with with it, and then your doctor says, well, your numbers are still climbing. And you think, Well, gosh, I'm doing everything. And it was working. What is the point now, if you're gonna throw medication at me, despite my really good efforts at doing everything, and that's where you know, and working with a lot of type two population in the past. There's a lot of like, defeat in that. And the explanation that I always give is, your your type two is a it's a progressive condition. It is. And at some point, you may need medication. At some point further down the road, you may need insulin, it does not mean that you failed, it means that you've had this amount of time that you've really given your all and you've really done a great job to keep your body healthy. So you know what, now when medication gets added, it will likely work for a really good amount of time as well before potentially needing to progress on to another kind of medication or even insulin.
Scott Benner 34:55
I have a recording already done and I have another one coming up with a with Both with type twos, who through the podcast have really astonishing outcomes like really well, a woman with a, an A one C, I just saw her online the other day in the Force. She's so excited, you know, and I was so happy for it. And I've already recorded with her and she's such a character and so wonderful. I can't wait to put it out. And then I have a guy coming on, who not only got his a one CD together, but his blood sugar's and his weight and all this stuff is happening from a podcast that I started, so my daughter would know how to Bolus, you know, like, that's really crazy, right. And as like you and I talking today, I have so many notes in front of me about what I want to do with the podcast moving forward. I just, I can't wait to try to help more people. The I don't know, Jenny, if you know this, but we are recording on the first of April. And we are here, right? Yes, it's April Fool's Day. This is not a joke. But the podcast in the first exact 90 days of 2022 had a million downloads.
Jennifer Smith, CDE 36:05
That's super awesome.
Scott Benner 36:06
it the year before it took twice as long to get to a million in that year. In a couple of weeks, the show will have a total of 6 million. And I think a year from now, it'll be more like 12 million total downloads. That's super, that's super, it's insane. Like I what I see, I see it
Jennifer Smith, CDE 36:29
honestly is super in terms of that's the number of people that it's reaching. I mean, I'm excited for you. That's super awesome. From what you've been able to put out and be able to do. But I'm excited from the standpoint of the people that that means it's helping in some some way they're getting something out of it.
Scott Benner 36:48
That is That is how I think about it. I also think about about paying my bills, but that's a different situation. But I really do, I mean seriously, to be serious, like I really do think about it that way. Like I used to have that. I know I've said it before long time ago on the podcast, it as close to the feeling is I can describe to you. When you help somebody like this when you do something and you see it help a person and I mean really help them like a person with type two tells you they're a onesies, 4.5, or a person with type one tells you, hey, I just ran a marathon based on what I experienced from your podcasts or my A once he's been in the fives for three years because of what I heard from you. It just sounds completely bizarre. I'm telling you that when I reached 10 people, I immediately think, why couldn't I find 100? And when I found 100, I think why can't I find 1000? In the first time I got to 100,000 I thought this could be a million. And
Jennifer Smith, CDE 37:42
you're like, where are all the people hiding? And how can I find them to give them what's important? Well,
Scott Benner 37:47
when you see them when you see what happens for them. And then you realize that the the really one of the only thing standing between them in the situation they're in now in the situation they could be in is just access just hearing it one time. Like you think like my whole, like 24 hours a day should be about I should be walking around with a sign right? Like, says Pre-Bolus on it is your right, I don't know, you know, like you start to have that feeling I have over the years alleviated myself from some of that guilt, which and it was guilt in the beginning. Like I felt like I wasn't helping enough people. And now I just see it as I know, this thing helps them and how do I get it to them. And so the people listening are how it happens. They spread differently. It's amazing share
Jennifer Smith, CDE 38:33
sharing it. I mean, and I think that's, that's an important piece. I mean, I I've met two or three people just in my community who have either mentioned it not knowing who I like, or that I contribute anything Association, but just in passing kind of thing. And I met one actually at our community pool last summer. A mom and her little girl and her daughter had noticed my Dexcom on my arm and I could tell that they're kind of like looking at me and she came over and she's like, we just wanted to say hi because my daughter also has type one and she noticed you know, your your Dexcom and we got to talking and we introduced names and I was like going Jenny, you know and she's like, you're not chatty. Like Jenny in what way and she's like, Do you are you on that podcast? Like me? Yeah, you had your airport
Scott Benner 39:31
moment. That's lovely.
Unknown Speaker 39:33
Did it was lovely.
Scott Benner 39:35
I think the kids call that meta, don't they? I don't know. I don't I don't have time to define meta. We're out of time. But that is
Jennifer Smith, CDE 39:44
just so nice. You know if when you hear back like that, it's
Scott Benner 39:47
it's amazing. I don't know. I don't know another way other than Mike hamfisted comparison to a movie. That's about a real life tragedy. And I even as I'm saying and I'm like don't make this comparison it's not a comparison. I'm Trying to it's that feeling. It's that moment in that movie, where he thinks I should have done more. I used to I used to feel like that constantly. Like, why am I not doing more? And then and then when it starts doing this, you're like, oh, it's working. You know, and I shared that thing with you yesterday. Yes, yeah, that's just insane that a woman was messaging with her doctor. And I want I want to pull it up real quickly. If she's messaging with their doctor about a problem, and the doctor responds, the doctor, the endocrinologist responds, and says something like, Hey, you know, might not be a bad idea to do this. Blah, blah, blah. There's a Juicebox Podcast episode about that. It's number 263.
Jennifer Smith, CDE 40:44
When you texted to me, I was like, and this doctor, like, knew the episode number. I don't even know that I have to look the episode numbers up. I don't even know.
Scott Benner 40:53
I'm the worst person to ask about what's in this podcast. And I'm so busy making it I don't know anything about it. But it's, I saw that and I thought, oh, my gosh, that's incredible. Like, it's only the is a podcast is only eight years old. It only really started flourishing four years ago. And today, somebody's being messaged by an endocrinologist. Hey, listen to this podcast. I was I was as proud as I could have been when I saw that really, really something else? I'm sorry. Did we do justice? Just do an overview of type two diabetes?
Jennifer Smith, CDE 41:22
We did? I think it yes. In fact, I think the only other thing that I think probably would be of interest at some point might need to be added to your plethora of notes that you have there. Now, we've talked a lot about insulin. But there are so many things to get into in terms of meds.
Scott Benner 41:39
Yeah. Do you have five minutes or do you have to go?
Jennifer Smith, CDE 41:43
I have to go I yeah, I would love to but it would be more than five minutes you're
Scott Benner 41:47
you know, I don't mean about that. I what I was gonna say is that I have a list a list of things here from people that they want added to the defining series. Oh, awesome. And the meds was on there. So I'll break this list down and put it in our shared folder file so you can see it cool. But I really appreciate you doing this with me today. Thank you so much. No problem. Have a good weekend.
Jennifer Smith, CDE 42:09
You too. Thank you. Bye.
Scott Benner 42:17
First, I'd like to thank Jenny Smith and remind you that she works at integrated diabetes.com She's for hire, you can get ready to help you with your diabetes. Let me also thank us Med and remind you to go to us med.com forward slash juice box where to call 888-721-1514. To get your free benefits check us med take the survey AT T one D exchange.org. Forward slash juicebox. Find the diabetes pro tips at diabetes pro tip.com or juicebox podcast.com or by going to Episode 210 In your podcast player.
If you're listening to the podcast right now in an audio app, but you're not subscribed or following, please subscribe and follow to the Juicebox Podcast. If you love the podcast tell a friend about it. Best way to help the podcast is to tell someone else about the show. I think this is all I have for you right now. So I'm going to go but you know what I want to say before I leave. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
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#677 Defining Diabetes: Hypo and Hyper
Scott and Jenny Smith define diabetes terms
Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Hyper and Hypo.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google 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 friends and welcome to episode 677. It's a short one, but it's good
Hello, everybody on this episode of The Juicebox Podcast, Jenny Smith and I will be defining hyper and hypo as it relates to all things, not just diabetes. Please remember, while you're listening that nothing you'll hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician. Before making any changes to your health care plan, or becoming bold with insulin. I'm going to just ask you the briefest of favors. If you are a US citizen who has type one diabetes, or is the caregiver of someone with type one diabetes, please go to T one D exchange.org. Forward slash juicebox. When you get there, join the registry take the survey takes fewer than 10 minutes, I would consider it a personal favor T one D exchange.org. Forward slash juicebox. If you're enjoying the Juicebox Podcast, please share it with someone who you think might also enjoy it. If you're loving the defining diabetes series. There are so many of them to choose from right there in your podcast player, where diabetes pro tip.com. This episode of The Juicebox Podcast is sponsored by us med. US med is a place where you get diabetes supplies, and they do it. Well they do it better. They offer you better service and better care than you're accustomed to getting. All you need to do to get a free benefits check is to go to us med.com forward slash juice box or call 888-721-1514 Hi, Jenny. Hi, Scott. How are you?
Jennifer Smith, CDE 2:05
I'm fine. How are you today?
Scott Benner 2:07
Good. Have you seen the little animations of you and I talking on Instagram and and Tiktok yet?
Jennifer Smith, CDE 2:14
I have I saw when you originally showed me what was going to be there but I have not seen recently. Because I have to admit I'm not a tic tac, or Instagrammer.
Scott Benner 2:26
So the person making the videos Maggie, who is a great young artist whose sister has type one diabetes. She has now added what I'm gonna call googly eyes to us. So while we're talking now the eyeballs move around inside of the eyes. Oh no, I'm absolutely like enamored by it. So
Jennifer Smith, CDE 2:43
I'm sure that if I showed it to my boys, they would probably think it was the coolest thing in the world to see
Scott Benner 2:47
your voice coming out of a cartoon. Yeah. Oh, yeah. All right. Well, you should check it out. I don't think you should get on Tik Tok because I have to tell you, it really is a time suck. Like it is it is the scrolling. Like I got it just to put this stuff, you know, for the for the podcast app. And then I'm like scrolling and I'm like, oh my god, I can see how people get lost in this. It's fascinating. So
Jennifer Smith, CDE 3:06
yes, I have stay away. I have more things that I need to do then.
Scott Benner 3:11
Yeah. If you're not on Tik Tok, you're doing okay. I think I was hoping today that we could define something that I mean, in all honesty, I had skipped over we I'd made a list and thought this isn't necessary. But it is. So we're going to do it. I want to define hypo and hyper just those words, and then we'll attach them to diabetes, and a couple of other things. So you know, everybody understands, again, Isabel helping me with the Facebook page, she said, I know this seems basic, but you really could use an episode on what hyper and hypothyroidism is people ask especially new newly diagnosed people, we don't have anywhere to send them. So here we are. Great. Awesome. Okay, so let's start like super simple, right? We're just going to use the dictionary. Hypo is a noun, and it means
Jennifer Smith, CDE 4:11
under or beneath a level of where you want to be. Right? And, yes, I mean, hypo hypoglycemia, hypo thyroid, hypo, many other medical terms that come along with hypo, it is like, it's low, right? It's under where a level of comfort would be.
Scott Benner 4:35
I also should have said and this is going to be a good indication to all of you that I stopped paying attention to my English teacher in about seventh grade, but it actually can be used as a verb as well, but we mostly think of it as a prefix, under beneath down less than normal, in a lower state of oxidation, for example, in a low and usually the lowest position in a series of compounds. So glycemia You know, I didn't think of this but darn it. Let's define. Let's define glycemia for a minute. Why not? I don't even think glycemia is a word, right? It is the presence of glucose in the blood. Now I'm learning. Yes. All right, like this podcast, okay? Jenny, then you
Jennifer Smith, CDE 5:21
can then you can put them together low presence of glucose in the blood. Yeah. Jenny, I hypoglycemia.
Scott Benner 5:29
I was gonna say I would listen to this podcast. Okay, so glycaemia the presence of glucose in the blood. So hypo, beneath normal, less than normal, presence of glycine, of glucose in the blood, and then hyper, which, if you've anyone's ever had a hyper kid, you know, this won't sound crazy, highly excited, extremely active, excessively excessive. That is or exists in a space of more than three dimensions that one doesn't really like It's like hyperspace. Oh, yeah, I really should have paid attention in school. This is all very interesting. I feel like an idiot. Okay, so but excessive, is where we're going to ride on this. So hyperglycemia excessive presence of glucose in the blood. That's it. Now, why somebody couldn't just call it high blood sugar and low blood sugar. You know, smart people, doctors, they fancy.
Jennifer Smith, CDE 6:25
Right? Well, and they're just medical terms, right? I mean, hyper and hypo, even in the sense of other medical conditions that carry that same prefix, if you will. They're just a medical term, rather than saying high and low blood sugar or high and low blood glucose even I also think, just glucose and sugar, right? I mean, when you say, my blood sugar is this, some people say my blood glucose is this, it's just another word for the same thing.
Scott Benner 6:54
Do you have a preference? Personally, when you write it out? And you know, someone else is gonna say it? Do you think blood glucose or blood sugar? How do you write it out?
Jennifer Smith, CDE 7:02
I abbreviate the G, because that's my quick way to type up something.
Scott Benner 7:08
After writing blogs, for so long, I did the same thing. But in the beginning, I had this like this blood sugar sound. I don't know. Like, I like this is not sound, I don't know, appropriate or something like that. But I don't think of it now. It's however it comes off my fingers when I'm typing. Like when I'm talking to somebody, I don't think of it one way I don't care. I
Jennifer Smith, CDE 7:28
guess if you, if I think about when I write about it, when I'm writing more professionally, I use the term blood glucose. And when I'm writing more from just a general kind of public, I typically use blood sugar. Okay, not that people don't know what glucose is, especially within the diabetes realm. I just think that blood sugar is often more what we say. Yeah. And so it's more readable. I don't know if that makes sense.
Scott Benner 8:02
Yeah, I think it just makes it feel more affable, honestly, just sure available to people. As an example, and we're not going to turn this into a third grade English lesson, but hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone. So back to hypo, low last, etc. Hyperthyroidism, the overproduction of a hormone by the butterfly shaped gland and the neck called the thyroid. Excessive too much. I just pulled up a couple of other words to make the point that it's not always about. It's not always about medicine. Hyperbole, as an example, is an exaggerated statement. We're claimed not meant to be taken literally hyper hyper. Right? Is the prefix. My, my last thought is just to get away away and Jenny used to be a nurse. Right, Jenny? What is hypo perfusion?
Jennifer Smith, CDE 8:56
Good to correct you I wasn't a nurse, or I'm not a dietician.
Scott Benner 9:01
Sorry. It's the same thing.
Jennifer Smith, CDE 9:05
Oh, well, you know, if I had thought that when I was going to school, then I probably would have ended up being a nurse. But yeah, so that different,
Scott Benner 9:15
I make a suggestion. Sure. We'll have to add CDE to the defining diabetes series.
Jennifer Smith, CDE 9:23
That would be great because you can have many credentials that precede CDE, which is actually not CDE even anymore. It's now c d c e s certified diabetes care and education specialists to make it even more complicated than it ever was.
Scott Benner 9:40
Have you given over to that yet? Because you you said you were gonna fight it in the big guy
Jennifer Smith, CDE 9:44
in credentialing just in terms of my signature and the way that I you know, put, again, sort of publications and that kind of stuff out I do. But I still call myself a CDE because I that's just like, what I've been long term.
Scott Benner 9:59
I have to Say I like these. Oh my gosh, I've gotten too hot tea and it doesn't matter. Oh no. I'm just gonna start drinking scalding water. When I'm recording from Elon just, I'll drip a little lemon in it and pour down my throat. I was gonna say I like the free flowing pneus of our conversations, because my just miss speaking for a second, immediately made my brain go, Hey, why are we not defining this stuff for people? Because people all the time, say, who just see today? I don't know, I saw the lady. You don't I mean, like, the doctor is the doctor, an endocrinologist? I don't know, what's the woman I don't know. Like, like, you know, she writes the prescriptions. It seems like she's got a medical degree.
Jennifer Smith, CDE 10:37
That's I saw these people. And they told me to do this. And I don't necessarily know what they are, you know, in fact, in terms of like that defining of even clinicians, many endo offices now sort of transition often on between, you see the Endo, you see the nurse practitioner or you see the Endo, or you see the PA, a physician's assistant, right, and you go back and forth. So it's not every three or four months, you're seeing the same Endo, you may see them only twice a year and in between, you actually follow up with the nurse practitioner, the physician's assistant, because that's the time that they have.
Scott Benner 11:13
So my brain like, I know, you have a firm background in nutrition. Like I understand all that. And I guess my brain just was like, well, she's the CDE she must have had to have been a nurse in the middle of it. And now so Okay, so we have more stuff anyway. Just
Jennifer Smith, CDE 11:27
remember things in nursing school that I was like, Yeah, I don't want to do that. I don't want to ever ever do that to a person. So no, I'm not going to be a nurse.
Scott Benner 11:37
Well, then just for fun.
Jennifer Smith, CDE 11:38
I I very much appreciate the nurses who do and can do those types of things. But I That's not me. I can do blood. You could bleed all over me. I could do wounds, weird looking gashes.
Scott Benner 11:51
Where's the line pee?
Jennifer Smith, CDE 11:53
Oh, the line is mucus. Oh,
Scott Benner 11:57
I wish you could have saw the face Jenny just made we should make it a poster. I just sideways or tongue came out or one of her eyes went one way she's like,
Jennifer Smith, CDE 12:05
yes. No, I was I was an ICU dietitian. So I did like tube feedings and IV nutrition and all that kind of stuff. And I would have to move away when they were doing like suctioning of patients and stuff. I like the noises and not for you. Not for me. Nope. My Oh, come back. Thank you. My wife
Scott Benner 12:27
is like three clinicals away from being an RN. And I mistakenly got her pregnant before she could finish off. So I do remember that she never got back to it. But she even said that. She thought by the time if she would have finished she's like, I don't think I could have like actually helped people. Like it just was Yeah, her vibe. And it wasn't about the people. It was more about the that stuff. Okay, but anyway, just for shits and giggles Do you know what hyper perfusion is? Now that I brought it up? Because if not, I gotta tell people.
Jennifer Smith, CDE 12:57
What and why? I'm curious actually. Why?
Scott Benner 13:00
Because it had the word hypo in it. And I thought I wonder if anyone just randomly know what this is? Oh,
Jennifer Smith, CDE 13:05
well, it has to do with like blood flow. It's hyper. Hyper is more and hypo is a reduction in the amount of blood flow.
Scott Benner 13:15
This is why you're listening to the podcast because Jenny knows stuff about stuff she doesn't know about. Hypo fusion has nothing to do with diabetes, but it describes a reduced amount of blood flow. There you go. You can't trust somebody who knows stuff. They're not supposed to know who you're supposed to trust.
Jennifer Smith, CDE 13:29
Correct. There you go. Well, thank
Scott Benner 13:31
you so much for doing this. I
Jennifer Smith, CDE 13:32
really You're welcome. Absolutely.
Scott Benner 13:36
That was good. That was hilarious. Actually. It's always fun. Good time. All right. hyperperfusion. I'm getting rid of tabs on my
Jennifer Smith, CDE 13:43
Yeah. Are we stalled for a second? I need to I think I forgot my orange link in my kitchen. And I need to go grab it because my loop is red right now. We'll be right back.
Scott Benner 13:54
No problem. While Jenny's off getting her orange link. I'm going to tell you about today's sponsor, US med
just the other day, I had Omni pod send Arden's prescription for Omni pod five over to us med. All of this happened without problems. That's what we want. Right? Nice and easy access to our supplies. US med offers that with their white glove treatment. US med accepts Medicare nationwide and over 800 private insurers. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM, like FreeStyle Libre two and the Dexcom G six. US met always provides 90 days worth of supplies with that fast free shipping that I've been telling you about. If you want better service and better care than you've been accustomed to getting with your other suppliers, check out us med. They've helped over 1 million diabetes customers since 1996 are the number one rated distributor index com customer satisfaction surveys, the number one specialty distributor for Omnipod dash, the number one distributor for FreeStyle Libre, and the number one fastest growing tandem distributor nationwide. US med get your free benefits check right now. Us med.com Ford slash juice box or call 888-721-1514. There are links to us Med and all of the sponsors in the podcast player shownotes that you're listening in right now. Or at juicebox podcast.com. And don't forget to take that T one D exchange survey AT T one D exchange.org. Forward slash Juicebox. Podcast support T one D exchange, you're helping people with type one diabetes, and you're supporting the Juicebox Podcast, keep the show free and plentiful by supporting the sponsors.
on next week's defining diabetes, Jenny and I will be defining all of the different types of diabetes. And there are more than you think. To find a list of all of the defining diabetes episodes, go to Juicebox Podcast type one diabetes on Facebook, it's a private group for people who listen to this podcast. And right there at the top of the page. You click on a little tab called where the is it God, I can never remember the name of this. I'm going to curse. I'm going to curse. I don't want to curse just trying to finish this ad and I'm done for the week when I get this done. Like I actually get a day off tomorrow. I mean, I still have to record but I don't have to edit and I just want to tell you the name of this. Featured, you go to the Juicebox Podcast type one diabetes, it's a private Facebook group. Almost 25,000 people in it. They use insulin, they chat with each other, they help each other. And under the featured tab at the top. There's lists of episodes in different series, including the defining diabetes episodes. So if I didn't sound too crazy, just then maybe you'll go check them out. I just didn't want to curse. That's the end of my week and I had knee surgery. I'm feeling okay, but I'm not supposed to be sitting here right now. I'm supposed to have my flights. This is not your problem. Just go find that. Just go find it. It's Juicebox Podcast type one diabetes. It's a private group answer a couple questions you get right in. It really is a magical place. I'm not kidding
you. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!