#1222 Bold Beginnings: Injected Wrong Insulin

June 11, 2024Scott Benner

Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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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 1222 of the Juicebox Podcast.

Today, Jenny Smith and I are going to talk about one topic. That topic is What do I do if I inject the wrong insulin? Now basically what that means is you're about to inject your Basal insulin and you do it you know, what do you get like 2030 units of basil a day, whatever your number is, and you won't put it in and whoopsie daisies I put in my mealtime insulin. What do you do? 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. If you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC as a registered dietician, and a type one for over 35 years. And in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. This series begins at episode 698 In your podcast player, or you can go to juicebox podcast.com. And click on bold beginnings in the menu. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven dexcom.com/juice box. And by the way, Dexcom now pairs with your Apple Watch. Check it out dexcom.com/juice Box. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Jenny I thought today we could talk about what to do. Like I want to have a nice, small, all in one episode about what do I do if I inject the wrong insulin? Oh, that's a good one. Yeah, it happens to people and the time to start thinking about it isn't when it's happening. So I'd like people to know ahead of time what to do. So good. I was gonna say

Jennifer Smith, CDE 2:41
I think something else that goes along with it too. Although most, most pumps now have a protection feature to dosing too much even have the right insulin right one unit versus oh my gosh, I took 10 units because I didn't realize what buttons I was pushing. Right? Yeah, but I think it's part of the same,

Scott Benner 2:58
it's still happening. Also, I have a story that I'll tell during this that will. I didn't know what I was gonna say there. I always think of every time I think of saying something that will shock somebody I think of the line from the Julia Roberts movie, where she's famous. And Hugh Grant owns a bookstore. What is that movie? Do you know what I mean? I know they fall in love. And there's a crazy roommate of Hugh Grant. Anyway, he says, I'm going to tell you a story that will shrink your balls to the size of raisins. And I think of that every time I think of this and I have a story like that about somebody getting too much insulin, which I will tell awesome later, let

Jennifer Smith, CDE 3:34
me just say no, the roommate is always in his underwear. Yeah, I don't know the name of the movie. But he's like a crazy and he's British, and he's got the most horrible t

Scott Benner 3:43
this is ridiculous at the end are on the park bench. She's pregnant, it's happy. I'm an art. If that doesn't come to us, we'll look it up at the end for all the people who are yelling at their headphones right now and already know the answer. Okay, so here's what could happen. And now listen, if you're not MDI, like Jenny just said, Hold tight, this applies to you as well. But moreover, what ends up happening normally is that people at the end of the day or in the early morning, when they're tired, grab their fast acting insulin or mealtime insulin instead of their basil or their slow acting insulin and inject a lot of fast acting insulin instead of basil. So yes, yeah.

Jennifer Smith, CDE 4:20
And I would say that's correct in terms of the majority of MIS used insulin type. That's it is somebody meant to take their basil, and instead they took their rapid acting, it's not common that I find the other way around. Yeah,

Scott Benner 4:37
and if that happened, you just be like, Oh, well, whatever.

Jennifer Smith, CDE 4:41
Maybe I don't have to inject you know, rapid today because I've got so much basil in the background, right, but it could just eat all day,

Scott Benner 4:48
but it doesn't feel as like immediate Yeah, like it has to happen right now because it does because, listen, even if you're a if you're a kid, even you know and you inject for Five units of Novolog, let's say when you meant for it to be, I don't know, 11 meter or transceiver or something like that that's a significant thing because most people know for their kids, five units is a ton. And then when you get into adults, they could be using 2025 30 units of Basal insulin. And now all of a sudden, you've got 25 units of fast acting insulin, but let's pick round numbers. So we can do this well, okay. Okay. Let's say you meant to inject, I don't know 10 units of basil. And instead you injected 10 units of fast acting. And your insulin to carb ratio is one unit covers 10 carbs. This is a nice way to conversationally, very easy math, right? So I've seen people panic. I've seen people call 911. I've seen them drive to the emergency room. I very frequently wonder why people don't just think, Well, I wonder what my carb ratio is here. How much would I have to eat to counteract this?

Jennifer Smith, CDE 6:00
Right. And that should be a it should be a first thought. But I also think, as you said, it's a Oh, my goodness, what did I just do and panic sets in. And you think that was a lot of insulin and especially for? I think from a clarification, as you said, already, kiddos, many little kids are very sensitive to insulin. So a whopping 10 units of rapid insulin, when it shouldn't have been, could have been a lot of extra insulin versus an adult who maybe could actually cover that pretty easily with some simple food,

Scott Benner 6:37
right? And maybe wouldn't be a crazy amount for them to begin with as a meal Bolus. But just to keep your head about you. If one unit is 10 carbs for you, and you put in 10 units, you need to eat 100 carbs. Yes, not that much. But

Jennifer Smith, CDE 6:57
But I think the timing there of putting it in. Thankfully, we have CGM where you not only took the amount of insulin now you've got it? You're okay. Okay, I've got this. I know how much I took. Let's put all the pieces together. Where is my blood sugar? Where is it heading? Is it stable? Is it rising? Is it already falling and lower to begin with? So those are all parts in the decision of starting to put food in to cover this excess?

Scott Benner 7:26
Right? What kind of food is that? Because of digestion absorption? Am I going to cover the 10 units in time? So if you panicked, for example, and said, I don't know, see, I guess this is the problem. Like I like doing this in real time. Because what food would I go grab? And like? Do you start thinking a hundreds of big numbers, so I have to get something that's like a lot or like instead of thinking like, let me put in some fast acting sugar and then go get something that digests a little slower.

Jennifer Smith, CDE 7:59
You're right. And that's where you're now thinking as someone should be thinking, Okay, where's my blood sugar? Is it in target? Is it dropping? If it is you're looking at that 10 units now, probably a little bit more simple carb upfront, to really stabilize out whatever drop was happening already before the 10 units right. And then once you've got stability, then again, action of rapid insulin is about let's call it four hours, it's three to five hours, but on average about three to four hours so you still have you still have a timeline of its action to cover that 100 grams doesn't need to be eaten in 15 minutes. If

Scott Benner 8:42
you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily Jeeva Capo pen can be administered in two simple steps even by yourself and certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Tchibo Capo pen before an emergency situation happens. Learn more about YG vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit GE voc glucagon.com/risk First, right? You get out of it. Right? So stop the initial drop from crashing you with Some food buoy and a little bit, if you will, like you know, hold it up a little and then go a little slower eating forward, watch the clock, watch your CGM or test if you start drifting in the wrong, like drifting up, you think maybe, oh, maybe I got this now. Right,

Jennifer Smith, CDE 10:15
and then you let the drift happen at that point, you definitely still have insulin Now let the drift happen. Yeah, I mean, you don't like high blood sugars. But this is a different scenario of a high you were trying to prevent what you didn't plan to do to begin.

Scott Benner 10:28
We're also trying to go without saying it. And maybe we should just say it here like you're trying to prevent, like dying is what you're trying to prevent? Yeah. Yeah, let's run the risk of having a high blood sugar for a few hours until we're sure that insulin is gone. Right? I do see people at times, they run to juice. And they start panicking and trying to get all the carbs and the juice, but I want to I want to tell you, you can get what I call juice sick. If you do that, like you're like your stomach, and then you're in trouble. Because if you vomit, or you can't eat anymore, and you still need more, you're going to be in trouble there as well. If you're trying just to cover with correct with

Jennifer Smith, CDE 11:05
food, right? Which is again, the reason for some of the timing of intake, right? If your timing that out giving a portion upfront watching the CGM, you know, watch it every 15 to 20 minutes digestive Lee you have to get get some time going for that food to move in, really get absorbed. If you want to speed some absorption because you were dropping already, you may do some warm liquid along with the simple carbs, because that does speed up absorption and the rate of kind of digestion. So it gets things moving a little faster to stabilize things out. And then eventually with stability, you know, okay, well, I covered this much already, there's still this much, let's say five units was still uncovered. As long as you've got stability, you may start putting in the rest of the food to cover that five extra units in a little bit more complex food. So that, you know, so that it doesn't really cause a big spike and then drop you off yet again,

Scott Benner 12:02
because of digestion. So I'll say this, if you haven't listened to the Pro Tip series, I think if you listen to the Pro Tip series, when this happened, you would just do what Jenny and I are saying kind of naturally, right? Because you you'd have a concept of timing, and amount, right? And so but if you haven't fair enough, what did you just say about the warm liquid? What does that do that helps your body pull up the sugar?

Jennifer Smith, CDE 12:28
Yeah, so warm liquid actually speeds the rate of digestive to a degree and so that it increases the ability for your body to digestive ly absorb that food or that carbohydrate, especially faster, so that you're you know, you get a little bit quicker response. You know, again, if you were dropping honey in warm water is lovely. It five grams per teaspoon, it works pretty quickly. You're getting it into your system, it's also not volume, you're talking about juice sickness. There's only so much liquid you can put in before you start feeling yuck right to teeny tiny amounts, maple syrup or honey, even a teaspoon of like regular sugar can be easy to get in and it's not this large volume of

Scott Benner 13:14
food. That's a good point. Like even the juice boxes that aren't and still carries to this day for Lowe's are very tiny. But we I mean, I guess I did a lot of juice box research at one point in my life, right? Like, how can I get her the least volume of liquid that she still is okay with the taste of that will get her the most carbs because we're not using them for pleasure. You know, we're not using them to drink we're using them to combat a low blood sugar. You know, I have to say, I sent her off to college six months ago with juice boxes. And I was like, Look, when you run out of them, you'll have to buy more. And she hasn't had to buy more. That's awesome. So exciting. Yeah, it's such a little thing. But like I love throwing juice boxes away when I pick her up at college. I'm like, Oh my God, you didn't use these like, it's fantastic. Yay. Let us go into digestion just Just a minute. So you can't just grab anything. The amount of people I see are like I have a little blood sugar in there. Like they have chocolate. I'm like that is not not an option. Not chocolate. Yeah, like I know because they think sweet or sugary, which is nice, but it's fatty and not absorbable being slow. Yeah. So simple sugars to stop the, I guess the way you have to think of it as you've just put in way too much insulin. And reasonably speaking, insulin does not work faster or slower. Because you've used more of it like inlet until you start getting into really bigger numbers. Yeah, value like if you start I mean if you put in, let's say 150 units instead of one and a half units, which by the way, hint hint is the story I'm going to tell you in a minute. So it let's say that happened, then yes, it's going to start dropping more quickly. But if you put in 10 And, and you know your normal Bolus is like for usually the, it's not like your blood sugar is going to drop 12 seconds later. Correct. So you have a little time. Now we're going to put in some fast acting easily absorbed stuff like juice like honey and warm water, that kind of stuff to basically start shooting your blood sugar up so that when that insulin starts to hit, it's fighting against the rise already. Yeah, kind of the opposite of Pre-Bolus for a meal, instead of causing a drop, that your food just kind of hold steady, you're gonna put in enough food that even if the drops happening, it can't overwhelm, right? Yes, right? Yep. Now you've got yourself saved for a minute, I'll take a breath. Right? And now do the do the math. How many more carbs do I have to cover here. But we're not going to do that with pizza, for example, because now your digestion slows way down. And the insulin has time to overpower the simple sugar that you took to initially. And now the pizzas not digesting. So now the insulin is there. And nothing's combating it. If you explain how to Bolus for pizza right now, that will solidify my example. Would you do that for me?

Unknown Speaker 16:12
How to Bolus for pizza? How

Scott Benner 16:15
do you Bolus for pizza? Sure,

Jennifer Smith, CDE 16:17
so pizza has a lot of carb, right. But it also has a lot of fat and potentially a lot of protein, which is going to draw out an impact. So you're going to do is you're going to give some upfront with Pre-Bolus, maybe 50%, let's call it. And then if you're doing multiple daily injections, you may do a split Bolus technique, a Bolus some up front you Bolus some maybe right after the meal or some maybe 30 to 60 minutes after the meal to catch the end effect. If you have a pump that does something like an extended Bolus can do some upfront and extend from that point the rest of it over a period of one to three hours, for example. So essentially, you're getting some, and then you're ticking in the rest as the food digests more slowly on the back end.

Scott Benner 16:59
So for those of you who have ever Bolus for pizza and thinking like, oh, there's 30 carbs, and every one of these slices, I'm gonna have three slices, here's 90 carbs. And the next thing you know, you're super low. It's because the insulin is working, the food hasn't started digesting enough for your body to pick it up. And to combat it. Understanding how to Bolus for pizza explains why you wouldn't use something like pizza in this example, like so I thought maybe that would be a good thing to

Jennifer Smith, CDE 17:25
absolutely make sense. I you know, and I think in terms of the technology we have today, I think another piece that should really help to decrease the panic in that scenario is you don't have to do a finger stick every single five minutes, right, you've got to CGM to be able to follow. The other really awesome thing is that in today's world, we have multiple options for glucagon. And if you really were worried, and you really didn't see movement on that glucose graph, and you did finger sticks, and they were verifying that the CGM is correct and your blood sugar is not rising, and you're worried. You have glucagon. Yeah, you could use it. Absolutely.

Scott Benner 18:05
And I just want people to understand how to manage it without it. But I'm not saying don't use it. If you get sick to your stomach, if you panic, if you like just better off alive with a high blood sugar. And we'll start over again, then that not I don't want to see a passing out. I also don't want to see what I hear happen sometimes. Once the panic goes through. People will put themselves in the car sometimes to go to the hospital. And I'm like, No, I don't want you driving. Your blood sugar's falling rapidly. You don't know when it's gonna tank out like putting, but I've seen it happen, like, yeah, there's a panic, then there's a froze, they freeze. Some people will go to the internet helped me I just did this, all I can think is there's five minutes there to open your phone to put up the posts or somebody sees it like, time is wasted. And then they're like, I don't have anything in the house, or I don't have this right. I can't make up that much. I don't feel well. I'm gonna go to the hospital. And I'm like, by yourself. Call my

Unknown Speaker 19:07
purpose of 911. Yeah,

Scott Benner 19:08
we don't want you to driving during the situation. But I think what happens is, is that any reasonable person who would not do something like that, in a normal situation, when the panic hits them, and they run out of options, they just go to what's left. And you know, if you really thought if you really thought you were about to pass out in your home, and you had enough insulin in you that it was going to do you in then trying to drive to the emergency room doesn't seem crazy. All of a sudden, you don't I mean, right? Anyway, I've just seen so many people have these experiences that I'm aware of where they go upside down at times. With all that said, you have to have this stuff in your house, obviously like if you have type one diabetes, and you don't have this stuff in your house. There's got to be an emergency stash somewhere of stuff Correct? Yes, you need to understand that simple sugar absorbs well through your cheeks, like inside of your cheeks. You You can rub like glucose gel in there. You can try tablets, you know, but yeah, use your use your glucagon if, if if you can't figure the rest of it out or if you're panicking because we don't want anything bad to happen. Oh,

Speaker 1 20:11
you know what? Good thought of the movie name.

Scott Benner 20:15
Wait. Oh now I feel weird. So, wait, we wait. So she's a very famous like in

Jennifer Smith, CDE 20:22
the back of my brain thinking while we've been talking about like, I know that

Scott Benner 20:26
she's super famous She's an American actress she comes to England to make a movie falls in love with a guy from a bookstore. They have a bit of a romance they break up again, Alec Baldwin shows up at some point. I know the entire goddamn movie. But what is it called?

Unknown Speaker 20:42
Can I give you a letter?

Unknown Speaker 20:44
I guess so go

Unknown Speaker 20:45
ahead. Ah, in this is in the second word. Second word. It's a two word name.

Scott Benner 20:55
I'm gonna be so embarrassed. I also let me tell you this. I've seen this movie like five times because my wife watches it all the time.

Jennifer Smith, CDE 21:02
Oh, really? I don't think I've only seen it like watched Oh, no,

Scott Benner 21:05
I could pretty much walk you through the script right now if I needed to at one point, she's making kind of like a bridgerton type show. And he shows up there and puts a headset on here's her talking to another actor about him. I know the whole thing. What? Don't tell me. Just okay. Okay. Let's keep talking. Okay. Okay, so be good.

Jennifer Smith, CDE 21:26
I was gonna say another component that I do think of it for those who are on pumps, this wouldn't apply for MDI. But it would apply for pumps, you do have the opportunity to subtract some of your Basal over the next couple of hours. Right, you could technically replace knowing again, insulin action is going to be a couple of hours of this bigger dose than you expected to take. And if you've got an insulin, you know, Basal rate that's like one unit an hour, you could technically for the next two hours just set us a zero Basal or a suspend, which could prevent that Basal from building behind this large dose, allowing some of that Bolus to just be replaced.

Scott Benner 22:08
Yeah, I would say that, like if your blood sugar was 130, and it was super stable for hours, you never any act of insulin at all. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has been at school, they're everywhere that she is contour next one.com/juice box test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter. You can find out about that and much more at my link contour next one.com/juice box contour makes a number of fantastic inaccurate meters. And their second chance test strips are absolutely my favorite part. What does that mean? If you go to get some blood and maybe you touch it and I don't know stumble with your hand and like slip off and go back. It doesn't impact the quality or accuracy of the test so you can hit the blood not good enough, come back get the rest without impacting the accuracy of the test. That's right, you can touch the blood come back and get the rest and you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times. That's not a good reason to have to waste a test trip and with a contour next gen. You won't have to contour next one.com forward slash juicebox you're gonna get a great reading without having to be perfect. Today's episode of the podcast is sponsored by Dexcom and I'd like to take this opportunity to tell you a little bit about the continuous glucose monitor that my daughter wears the Dexcom G seven the Dexcom G seven is small. It is accurate and it is easy to use. And where Arden has been wearing a Dexcom G seven since almost day one of when they came out and she's having a fantastic experience with it. We love the G six but man is the G seven small the profile so much closer to your body the weight, you can't really feel it and that's coming from me and I've worn one I've worn a G six I've worn a G seven I found both of the experiences to be lovely. But my gosh is that g7 Tiny and the accuracy has been fantastic Arden's Awan C's are right where we expect them to be. And we actually use the Dexcom clarity app to keep track of those things. That app is built right in to Arden's Dexcom G seven app on her iPhone. Oh, did you not know about that? You can use an iPhone or an Android device to see your Dexcom data. If you have a compatible phone, your Dexcom goes right to the Dexcom app. You don't have to carry the receiver but if you don't want to use the phone, that's fine. Use the Dexcom receiver it's up to you. Choice Is yours with Dexcom dexcom.com/juicebox. Like if your blood sugar was 130, and it was super stable for hours, you never any active insulin at all, and your Basal rate was one unit per hour. If you just Bolus two units, and then shut your basil off for two hours, you'd be very possible you wouldn't notice anything happened. Right? Right, like so those are those kinds of ideas that you need to apply in this situation for certain. Okay, so we've injected the wrong insulin or pump in more than we've meant to, these are ways to handle that. What if I do the wrong dose of? So here, these are actually questions from people. So what do I do when folks inject the wrong insulin? Like their fast acting versus their long acting? What do I do be aware of what's the next few hours? Like? What's the math behind it? I feel like we've covered all that, what to do if you take a double dose of long acting by accident, so that so I shoot my Basal insulin, and an hour later, I can't believe this does happen. Like I do it again. I go, Oh, my God, I Oh, my God. Now I have 20 units of my long acting going. It's almost, I mean, it's a completely different game now. Right? Like, because it's not, yeah, it would be

Jennifer Smith, CDE 26:17
a completely different. And again, depending on the time of day, if you're a Basal dose, at night, or, you know, in the evening, it's very, very likely, the best recommendation would be to have an uncovered snack before you go to bed, because you now have twice the amount of Basal insulin. And while we do you know, the newer insulins like true Siba, they tend to be much more flat. In effect, they don't really have a rise and then kind of a dip down at the end. Lantus is fairly flat, but it still does have a little bit of a surge in action and kind of like a petering out at the end. But in all, the best option there is again, to aim for a little bit higher blood sugar, especially overnight than what you would typically aim for, let's see for the overnight and uncovered snack, some good protein content to it, so that it has some sort of stability behind everything. The next day, though, and this is for those who might do their Basal insulin in the morning, now you've got double coverage. And as I sort of said earlier, it's very likely your doses for meals are probably going to need a downplayed dose, because now you have a lot of basil. The other potential is that you have to have a meal. And you may have to have some uncovered snacks between because again, there's a much higher amount of Basal insulin there than you wanted to have.

Scott Benner 27:43
So if your Basal is dialed in perfectly, and you're one unit an hour, you know, it's let's say it's 24, you should 24 units a day, because you're about one unit an hour. Now suddenly, you've put it in twice, now you have 48, if your stability is at 90 on the 24 units, with 48, your blood sugar is just going to constantly want to be low. So you're basically going to have to feed that insulin until it's out or until it starts to wane. And the newer ones don't wane the way the older ones though. So you might be 24 hours if you did this with the receiver, for example. Correct. Versus if you did it with Lantus or levemir, which would probably start to change around like 1820 hours, I'll tell you, yeah, okay. super interesting. Now, here's your story. So this is an interview that won't be out for a number of months here on the podcast. But this seven year old girl leaves in the morning, she's an omni pod user, but leaves her phone behind in her car when she goes to school. So the mother calls the school and says, Hey, you know, you're gonna have to go to the backup plan, let's we'll use MDI until I can get back to the school and drop off the phone, which I'll be able to do pretty soon. But you know, there's a thing coming up, you know, whatever it comes up, you know, go to the MDI, 504 plan, etc, has us covered for that. So the mom does some stuff, she gets to the school. And just as she gets to the school, she comes to the nurse's office, because that's where the kid is, the kid just got insulin for something. And the moms think so I'll go to the nurse's office and drop off the controller, the phone, whatever, and I'll be on my way and she sees the little girl who for some reason has two syringe marks inner instead of one like it just interesting, too, that she could see the syringe and she could see these two little syringe marks on a kid and she goes, Wow, how can we have like two little like, you know, how can we get poked twice? And the nurse says all the insulin didn't fit in just one syringe. Yep. And here you go. Johnny, take a minute to take it in. You'll want to catch this when it comes out because it's just me cursing a lot for for an hour.

Jennifer Smith, CDE 29:55
So the woman thought that literally all the insulin in the vial was a dose and had to go in.

Scott Benner 30:01
She wanted to give her a unit and a half and gave her 150 units of insulin. A seven year old. So the mom, as you'll hear in the Yeah, Yeah, no kidding, like really absorb it for a second. So when we talked about the if you put in enough insulin and a smaller about you know, in a body, it'll it started acting pretty sure on the kid right? So

Jennifer Smith, CDE 30:22
well and is going to last for quite a while because when you talk about volume, that volume of let's call it a unit and a half may take a little time to get moving like normal are Pre-Bolus. But then it's gone in a normal amount of time because that pocket of insulin into the skin is it's almost like a styrofoam ball instead of a Super Bowl ball. Right, that compact turning on rubbery. That's a large dose of insulin. And now despite having a three to five hour active insulin window, now you've got a tightly packed insulin that's inside of that ball of injected and that's going to take

Scott Benner 30:59
forever. Yeah, well, what it took was eight hours on a on a dexterous drip in the ER, yeah. So anyway, I won't ruin the whole story. Or the things I said I would do to the school nurse. But my God, but anyway, the mom, she first just she just tries to find a way that it didn't happen. Are you sure that's what you did like? So there's a couple of minutes spent in the office doing that. They live very close to the house where they live. And so she's fixed the kid in the car is at the house in two minutes. leaves the kid in the car runs the house grabs glucagon I'm not sure why glucagon wasn't at the school. But anyway, I bet she does. Now she hits the kid with the glucagon. But the kids already depan like I'm sure yeah, like she's she's her lights are going out. Right like so the she hits her with the glucagon, which pushes her blood sugar to like 74 long enough for her to drive her to the emergency room. Anyway, I she told me that story. I couldn't decide if I was gonna cry or scream when she was saying it. It was insane. Like, wait, did you hear her tell the story? That's

Unknown Speaker 32:08
like, I don't usually I have words for most things.

Jennifer Smith, CDE 32:14
But I don't have words like I don't even I wouldn't even have words in the moment. I wouldn't have wasted words on the nurse I would have, I would have moved with my child. And the words would have come later. Oh,

Scott Benner 32:26
I told her I said I said if that was me, I would have been shooting glucagon with one hand at choking that lady with my other one. And for clarity, because you definitely go find the story somewhere, wherever it isn't a podcast and good luck. I probably ended up naming it something stupid. You'll never find it. But a nurse in her 60s She was a nurse for 40 years and

Jennifer Smith, CDE 32:43
should have no mean insulin has been around that long drying up insulin. You can't tell me this wasn't the first child she's given.

Scott Benner 32:52
Right? But it goes to prove like what we were talking about a little like to come down on the side of the nurse for a second, right? Like what we talked about before, like, I don't know, how do you shoot 24 units of basil and then do it again. An hour later. He's because sometimes you just you get flummoxed and you just don't think of things. My real like sticking point was? Why would a needle manufacturer make a needle that doesn't hold enough insulin for an average seven year old to Bolus for a sticky snack? Like Like, right? Like, do you really think people are hitting themselves with multiple needles every time they eat? And that's where no common sense got involved at all. It didn't stop her. She just she gave the kid 150 units of fast acting insulin. Even like holding the vial. Wouldn't you say to yourself, oh my god, I wonder how many of these she must use hundreds of these vials of insulin every month. Like right? Like none of that kind of like common sense stuff. God tour, the kid knew. The kid threw up a flag when the nurse said oh, it just doesn't fit. I mean, she was seven. She was like, Oh, right on like, and she just sort of went with it.

Jennifer Smith, CDE 33:54
Right. You know what my my inclination would be in terms of how the mom could see that? There were two. I bet the nurse put band aids. Oh, I bet there were two band aids that I mean, because those injection spots. You can't rip. That would be my thing is that there were two little band aids and mom was like, Why do you have to bandys It's going

Scott Benner 34:16
on right now. Yeah. What's going on right now? Just the timing of it, Jenny? Yeah. If the mom gets held up for 10 minutes and doesn't show up at that moment, they send that kid back to class and she just dies in a room. You know what I mean? Isn't that terrible? Like anyway, so I'm sorry, I was just it was so upsetting, you should see. But anyway, if you hear the episode, I just at any point in the episode, start cursing and I get upset.

Unknown Speaker 34:42
It does happen, oh my god. But

Scott Benner 34:44
nevertheless, you are at some point in this game, you're going to end up with the wrong amount of insulin one way or the other. And knowing how to like deal with those situations is I mean, it's probably not going to Be 150 units when you meant to do a unit and a half, but you are going to make a Bolus one day and get sick in the middle of it not want to eat, or the the restaurant is going to come back 20 minutes later and go, Oh, we didn't have what you ordered? Would you like to order something else? And you're going to be like, Oh, wait, what now? Right? So this is gonna happen at some point. Yeah.

Jennifer Smith, CDE 35:21
And even in terms of, you know, sometimes get more emergent emails that are, you know, Susie just throw up threw up and we just gave her her dose for her dinner. Now, what do we do? It's kind of the same, it really is. Same idea. Really just covering it a little bit different way, obviously, if there's a stomach bug or something else in the picture, right. But yeah, it is. I mean, everybody makes mistakes. I have done this, that between basil and rapid, but I've done it because I was not. I was not paying as close attention to what I was dosing. And I took more than I was supposed to take because I was busy doing other things with my kids. And I went and I entered. And then I looked at my iob. And I was like, Ha, I shouldn't have this much. I'll be there.

Scott Benner 36:08
You know what I know that's happening with a pump what I see happen to people more frequently than anything else. It's not like saying to yourself, like, Oh, I'm gonna give myself five and giving yourself 10. It's saying to yourself, I'm having 30 carbs. And you're a one to three, you're a one to 10 for example, right? And instead of giving yourself three units, giving yourself 30 units because the the number 30 sticks in your head while you're dialing it up and you're paying attention to something else that is literally that's the way I see it happened with pumps more often than not correct

Jennifer Smith, CDE 36:40
absolutely or distraction. Again, mine was I mean, this is honestly in my memory is the only time that I've ever done it in terms of like that absent minded and I was supposed to take a unit and I took 10 units. And that's a lot of insulin for me, but I just enjoyed the attitude. Like I know how to take care of the cane

Scott Benner 37:04
while we were eating for real today.

Jennifer Smith, CDE 37:08
We are not taking a bike ride today.

Scott Benner 37:11
Listen, listen, have a meal or snack consume fast I think carbs monitor your blood sugar. Stay with someone avoid activity, contact your healthcare provider carry glucagon adjust your Basal insulin. These are things you can do. Yep, I never did it. But I almost did it. I drew it up. And I had it my hand. And I don't know what happened. But my brain was like that vial was the wrong color. That made you second thing thought me just long enough. And then when I went back, because they're both in the refrigerator. I don't know what I did. So I just I threw the syringe away. And I just started over again. Yep, I don't know. I get never I never made it all the way to the injection. But I've I've done that. I mean, I've also miscalculated carbs given too much insulin like that. I mean, it's gonna happen a lot of different ways. But listen, again, I just want to say at the end, if all else fails, glucagon, 911. Yes, absolutely. No, like, let's not have what what did my son's outfield coach tell him when he was when he was in Little League? Don't turn a mistake into a disaster. That's a yeah, yes. He cursed a lot while he said it. So it wasn't that nice. But that's what he meant. What he meant was just a bit. Yeah, you're gonna make a mistake. It's cool. Don't keep making them after that. And anyway, I hope this is helpful for people. I hope you hear it before you need it. That's my goal and making this one because like I said, the Facebook group. I'm gonna say monthly. Oh, my God, guys, what do I do? Yeah, I mean, so. And

Jennifer Smith, CDE 38:47
I think it goes along with just kind of in my circumstance, too. It's like the busyness of life, right? It is and you think you've gotten into such a routine that you're not going to make that mistake. It's a mistake. We are human. We will make a mistake at some point. And beating yourself up about it in that moment is not going to be helpful. So you just move forward. Okay, what do I have to do now?

Scott Benner 39:11
Try to keep your head about you the best you can. Yeah. All right now, Jenny, let's do something. I'll just embarrass my I'm you know what? I'm married. I'm not embarrassed by this. Okay. I've seen a lot of Julia Roberts movies. I don't think I've seen one of them on purpose. Or because I wanted to, but I have let's go through all the Julia Roberts movies. I know. She was in Mystic Pizza.

Unknown Speaker 39:31
Oh, that's one of my favorites. Okay.

Scott Benner 39:33
There's the one where she's the hooker. That one's called. Pretty, pretty woman. Okay, let's see if I can come up with them. There's that one where she's helps the lawyer. Erin Brockovich.

Jennifer Smith, CDE 39:45
Err. Oh, that's another thing I didn't like I like I have to say that. I really

Scott Benner 39:48
like can I tell you something. Erin Brockovich, the first movie we ever took call to Kelly, breastfed Cole in Erin Brockovich because we were so we had to get out of the house like so badly. had to get out of the house. Julia Roberts has been in those movies now she's been in a ton of movies. She was in that movie, where she had type one diabetes. And that one's called she

Speaker 1 40:12
the Southern 100 Steel Magnolia magnolia. That's an old Shelby.

Scott Benner 40:19
Remember that one? That one by the way, my wife's favorite movie till Arden got type one diabetes, and now we don't watch it anymore. And then, of course, there's what other movies has Aaron Brock. I just called her Erin Brockovich been in. Julia Roberts.

Jennifer Smith, CDE 40:36
Oh my gosh, well, and I know the one that you're trying to think of, but I'm not gonna say it until you can think about it.

Scott Benner 40:41
I literally could tell you that entire movie front to back. Why can I not?

Jennifer Smith, CDE 40:46
It's a she's also in my best friend's wedding. My best friend's wedding. There you go. Which is not this one.

Scott Benner 40:54
She's been in seven movies where her and George Clooney are almost dating. So there's all those I don't know the names of them.

Jennifer Smith, CDE 41:01
Oh, she's also I used to be a really big, a really big John Grisham. I used to love his novels. In Pelican Brief.

Scott Benner 41:09
Thank you. Right we're like they're on the house and it's raining and the crazy guy once the killer or something like that, right? Yeah. Hold on. Oh,

Jennifer Smith, CDE 41:18
you know the one that I really like it was a book is Eat Pray Love.

Scott Benner 41:22
Okay. I've never seen that. Really? That's a flex for my part. But okay.

Jennifer Smith, CDE 41:28
Yes, I'm I am. I'd be surprised if your wife Oh, I

Scott Benner 41:31
somehow got out of it is what I'm thinking right now. But the movie, by the way, here's the crazy thing about the movie I can't think of at the end of the movie. There's a montage where they like have their life together. And the and the song sheet is sung. Like I even know that. But I don't know what in the hell the movies called. And when you tell me I'm gonna bang my head on the desk. I'm gonna be so frustrated. I'm gonna go Of course. That's what it's called. It's called.

Unknown Speaker 41:58
Alright, tell me. Sure.

Scott Benner 42:02
I'm so upset with myself. All right, we have to go just told me.

Unknown Speaker 42:07
Notting Hill

Scott Benner 42:13
I'm so pissed.

Jennifer Smith, CDE 42:14
I love you. We won't tell we won't tell your wife.

Scott Benner 42:18
My wife has two rainy day movies. Notting Hill was one of them. Oh, the other ones Twister. Loves Twister. When like when the weather's bad. She puts Twister on the remaking Twister. She seems very excited.

Jennifer Smith, CDE 42:32
I don't like remakes. I'll tell you I think remakes are I

Scott Benner 42:36
might be an update. I don't know when it's gonna be but I saw Kelly. She's like, Oh, more twisters. She seemed pretty excited. Yeah. All right. Notting Hill. God dammit. That's really upsetting. You

Jennifer Smith, CDE 42:48
know, something I like about her as an actress too. For the most part. She does a lot of different like she doesn't get typecast. I guess. She's got a lot of variety in what she does. Like I really liked her in that they're kind of I consider them sort of gangster II The ocean's movies. Ocean's

Scott Benner 43:05
1111 Yeah, yeah, I

Jennifer Smith, CDE 43:09
think she was into two of them at George

Scott Benner 43:11
was there she's there. You understand? Yeah, they they seem to come off. Yeah. Hey, I can't call this episode drink your juice Shelby can i because people will get upset but that would be a really perfect title for this episode. It's I think it's great talk to you. Okay. All right. I'm gonna pull people in the Facebook group before I do that because I don't want Alright, thank you. Hold on. Yeah.

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