#1208 Defining Diabetes: Intramuscular Injection

May 26, 2024Scott Benner

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode we define Intramuscular Injection.

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Scott Benner 0:00
Hello friends and welcome to episode 1208 of the Juicebox Podcast.

Today on defining diabetes, Jenny Smith and I are going to define intramuscular injections. Nothing new here on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you have type one diabetes, or are the caregiver of someone with type one and a US resident, please go to T one D exchange.org/juice. Box and complete the survey. Your answers will help to move type one diabetes research board that may help you to T one D exchange.org/juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are now 50,000 members who are sharing stories and ideas. Go check out this amazing private and free Facebook group. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now that at the very end of the episode, you can hear my entire mini interview with Mark to hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. Jenny, let's talk about intramuscular injections. Oh, no, no, I am sorry. Is that how people talk about it? Yes. Okay, I'm outside of my depth here. So go?

Jennifer Smith, CDE 2:22
Well think about it. So right now we take insulin in the sub q tissue, right? That layer that kind of sits right underneath the skin, it gets absorbed. That's why our rapid insulin is not rapid, because it doesn't go into your circulating bloodstream and get used right now. Okay, I am increases the access to circulating blood because your muscles have lots and lots of blood in them. Okay, right. So if you take an injection directly into muscle, you are going to have quite an increased response to that insulin. Significant. Significant, okay. Yes. So why would you want to do this? The biggest reason within, you know, people who have diabetes, the biggest reason to do it is to drive a high blood sugar down fast. Okay,

Scott Benner 3:20
that's it. Yeah. Healthline says insulin should be injected into the fatty tissue just below your skin. If the insulin if you inject the insulin deeper into your muscle, your body will absorb it too quickly. It might not last as long and the injection is usually more painful. This can lead to low blood glucose levels. So you're saying that this fact about how injections work some people use to their advantage to try to break high blood sugar

Jennifer Smith, CDE 3:44
100% Yes. And another reason that I have seen it although it's kind of secondary to just addressing a high blood sugar is really for really high glycemic foods that you haven't pre bolused For or right getting it right into circulation is absolutely going to help you prevent a big climb in blood checks

Scott Benner 4:04
a fairly off label thing and I think we will Yeah, usually say this is a ninja level move. Just don't try this on your own. No, but

Jennifer Smith, CDE 4:12
and to be quite honest, it's pain. It hurts. Yeah, more than Yeah, I mean, stings is to depending on how deep you get it and where you put it and what you've kind of nerve wise feel like it stings, if this is not something that you're going to do just because you're like, Honey, the whole bag of Skittles today. Take this with my muscle jam

Scott Benner 4:33
this and my bicep real quick. So I mean, it's a thing people asked about and it's something you know about have you ever done it? I have personally never done it. Arden has never done it. So it's not a thing that is done with a lot of frequency. It's just the thing that some people do. Yeah, I you

Jennifer Smith, CDE 4:50
know, and there may be some certain circumstances where a high blood sugar me it may be beneficial to drive it down a little bit faster. Let's say Uh, you know, it's been high for a while you have ketones, you have ketones starting, and you really want to get that insulin moving. And it doesn't seem to be, it may be a great reason to do something like this. But again, it's, it's certainly something to do with caution. And you know, to make sure that you're not then, oh, my pump recommended a unit, I'm going to intramuscularly inject six units, please don't do that.

Scott Benner 5:25
Well, even Do you know what one to one even be too much? Like, if your numbers I don't know, let's just make up a number and say your 300 it won't move a unit should bring you back to 100. If you were gonna do I am, you wouldn't use the whole unit even right? Because you'd get a bigger boost out of you wouldn't need all that volume, it

Jennifer Smith, CDE 5:44
would be a good thing to downplay what the calculated amount would have normally been for a sub q injection or infusion. If you're going to try an im injection, then I would downplay the dose. Yes, as a starting place. Yeah,

Scott Benner 5:57
by the way, this is not either of us telling you to try this. It's just we're just defining the term, you can find NIH articles on it, the injection technique factor, what you don't know or teach can make a difference. That's what that is called. There's plenty of stuff online if you want to learn more about it. But that's what it is. Just in case you were wondering. And apparently a lot of people were wondering, because here it is on my list. I gotta be honest with you, I wouldn't do it. Like, especially like, I mean, I've now lived through watching art and go from two years old at 20 years old with diabetes, and I can't look backwards and say, oh, there's been a time I should have tried that. I should have done this year. Yeah, I don't I don't see that one. But okay. Anyway, we've defined it fair enough. That's it. Nothing here on the Juicebox Podcast should be considered advice, medical, otherwise, just say that twice. Just in case. Great. Yeah, I'm not, I'm not dying. Let's see.

A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made the finding diabetes, go to juicebox podcast.com, up into the menu and click on the finding diabetes, to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes, the diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise the hydration and even trampolines, juicebox podcast.com, go up in the menu and click on diabetes variables. And now my full conversation with Medtronic champion, Mark. Mark, how old were you when you were diagnosed with type one diabetes? I was 2828. How old are you now? 4747. So just about 20 years? Yeah,

David 8:02
19 years?

Scott Benner 8:03
What was your management style when you were diagnosed?

David 8:05
I use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 8:11
How long had you been in the Navy? See eight years up to that point? Eight years? Yeah, I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 8:23
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 8:27
I don't understand the whole system. Is that like, honorable? Yeah.

David 8:30
I mean, essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that's that's really how it happened. So it's an honorably discharged with but because of medical

Scott Benner 8:41
reasons, and that still gives you access to the VA for the rest of your life. Right?

David 8:45
Correct. Yeah, exactly.

Scott Benner 8:46
Do you use the VA for your management? Yeah, I

David 8:49
used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Scott Benner 9:02
Was it your goal to stay in the Navy for your whole life, your career? It

David 9:05
was? Yeah, yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we love the most. So that's what made it that much more difficult

Scott Benner 9:21
was the Navy, like a lifetime goal of yours or something you came to as an adult,

David 9:26
lifetime goal. I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being flying on and off aircraft carriers. So you know, watching Top Gun in the ad, certainly a

Scott Benner 9:39
weight was a catalyst for that you've taken off and landed a jet on an aircraft carrier. Hundreds of times. Is there anything in life as exhilarating as that? No,

David 9:48
but there there's a roller coaster I wrote at I think it was at Cedar Rapids up in Cleveland Sandusky, and they've got this roller coaster rotation from zero to like, it's like 80 or something. You go up a big hill and you come right back down. So the acceleration is pretty similar. I would say to catapult shot,

Scott Benner 10:06
I'm gonna guess you own a Tesla.

David 10:09
I don't I I'm a boring guy, I got a hybrid rav4 I get made fun of I get called, you know, my wife says, I drive like a grandpa on the five miles per hour over the speed limit person. No more than that. So yeah, in the car. I'm boring Scott. So

Scott Benner 10:24
you've never felt a need to try to replace that with something else.

David 10:27
You can't replace it. It's irreplaceable. That's what I thought. So up until the point where someone you know, buys me an F 18. Or allows me to get inside a two seater and fly it you can't replace it? How did

Scott Benner 10:38
it make you feel when you saw or maybe you haven't seen? gentleman named Pietro has his large aircraft license. He's flying for a major carrier. Now he has type one diabetes. Does that feel hopeful to you?

David 10:48
Yeah, it does. You know, when I when I was diagnosed, that wasn't a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason they did that was because of the technology advancements, specifically in pump therapy, and pump management. So I don't have any aspirations of going to the commercial airlines. But one of my sons who has type one diabetes very much wants to be a commercial pilot. So, you know, in that respect, I'm very hopeful and thankful. Yeah.

Scott Benner 11:20
Do you fly privately now for pleasure?

David 11:24
I do. Yeah, one of my favorite things to do is fly my kids to the different soccer tournaments they have all over the southeast us. So last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there. And Charlie, who's my middle child has type one diabetes. So you know if I can combine flying family and football and one weekend to me that's I think I've just achieved Valhalla.

Scott Benner 11:47
So then it sounds to me like this diagnosis was the significant course correction for you. Can you tell me how it affected your dream?

David 11:54
Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn't thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we were taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to how to deal with type one diabetes, and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Scott Benner 13:01
Have you had success with that? Do you feel like you've made the transition? Well,

David 13:05
I have I mean, I believe in continuous improvement. So there's always more to do. I will say the technology since I was diagnosed specifically with pump management, it's just, it's just incredible. It takes less of me intervening. And it's really done by the pump itself and by the algorithms through the CGM EMS. And to me again, that that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us. What

Scott Benner 13:34
else have you found valuable? I've spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don't have type one, myself, and my daughter was very young when she was diagnosed. I didn't really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don't know anybody else who has type one diabetes. I wish I knew more people. But until I saw them come together, I didn't recognize how important it was. Yeah,

David 14:03
I think similarly, I didn't know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all of a sudden, people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It's amazing to me and my family, how many people we've noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don't run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I'll give an example. We're at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed you're wearing pomp and he lifted up a shirt and showed his pump as well and said, I've had type one Diabetes since I was nine years old, I played soccer in college, I'm sure that's your aspiration. And I just want to tell you don't let type one diabetes ever stop you from achieving your dreams of what you want to do. And this gentleman was probably in his late 50s, or 60s. So just having that connection and seeing, you know, the outreach and people's willingness to share their experiences, it just means the world to us and just makes us feel like we're part of a strong community. So

Scott Benner 15:23
would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others? Yeah,

David 15:33
technology for sure. And knowing how to leverage it, and then the community and that community is your friends, your family, caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to, you know, help guide away, but then help help you keep abreast on you know, the new things that are coming down the pike, and to give you hope for eventually, you know, that we can find a cure, you

Scott Benner 15:54
mentioned that your son wanted to be a pilot, he also has type one diabetes, how old was he when he was diagnosed,

David 16:00
so Henry was diagnosed when he was 12 years old. That was just at the start of COVID, we are actually visiting my in laws in Tennessee, we woke up in the morning, and he had his bed. And several years before that, we had all four of our boys tested for TrialNet. So you know, predictor of whether or not they're going to develop type one diabetes, and whether or Henry and one of his brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it. But we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer. And it was over 400. And so right away, we knew that without even being diagnosed properly, by endocrinologist that he was a type one diabetic, so we hurried home, to get him, probably diagnosed in Charlottesville. And then we just started the process, first grieving, but then acceptance and, you know, his eventual, becoming part of the team that nobody wants to join,

Scott Benner 17:03
how old is he now?

David 17:04
He's 15 years old. Now,

Scott Benner 17:06
when's the first time he came to you? And said, Is this going to stop me from flying

David 17:12
almost immediately. So like me, he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation, and maybe something that we don't talk about as a community. But there are some things you cannot do as a type one diabetic, and that's a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be, you cannot join the military as a type one diabetic. So it was very difficult for him and for me and my wife to get over. Then we also started talking about being a commercial pilot. So I saw that same excitement in his eyes because like me, you know, he can be an FAA teen or a 737 or a Cirrus SR 20 That I fly and be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot. I appreciate

Scott Benner 17:57
your sharing that with me. Thank you. You have four children, do any others have type one?

David 18:02
They do? My oldest twin Henry has type one diabetes, and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes. My middle son, who is not a twin has type one diabetes,

Scott Benner 18:16
I see. Is there any other auto immune your family? There isn't

David 18:19
I'm really the only person in my family or my wife's family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately, pass it along to to my sons with

Scott Benner 18:34
celiac thyroid or anything like that. Not at all, nothing. We're

David 18:38
really a pretty healthy family. So this came out of nowhere for myself and for my two sons. That's

Scott Benner 18:43
really something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much. Anytime Scott, learn more about the Medtronic champion community at Medtronic diabetes.com/juicebox Where by searching the hashtag Medtronic champion on your favorite social media platform. If you're not already subscribed, or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com