#1447 Diabetes Pro Tip: Insulin Resistance

Jenny and Scott break down what insulin resistance and 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 00:00 Here we are back together again, friends for another episode of The Juicebox Podcast. Today I'm adding to the Pro Tip series. The rest of the series runs from episode 1000 to Episode 1025 it's also available at Juicebox podcast.com, up top in the menu, look for diabetes. Pro tip, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. 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/juicebox, don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout. That's Juicebox at checkout to save 40% at cozy earth.com. Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d, exchange.org/juice box. And take the survey. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa. This is the way this episode of The Juicebox Podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management. Imagine fewer worries about mis Bolus is or miscalculated carbs thanks to meal detection technology and automatic correction doses. Learn more and get started today at Medtronic diabetes.com/juicebox the episode you're listening to is sponsored by us. Med, us. Med.com/juice, box, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us. Med, Jenny, we're going to do something that we don't do that often. We are going to add to the Pro Tip series today. Yay. Right? We are gonna talk about insulin resistance.

Jennifer Smith, CDE 02:23 Oh, the fun of insulin resistance. Did you hear all

Scott Benner 02:27 the clicking? Everyone's like, reaching for their phone. They're like, Oh, I don't notice this.

Jennifer Smith, CDE 02:32 Turn this off. Let's fast forward and see if they talk about something. Guys

Scott Benner 02:34 say, insulin resistance. Did she pretend to be excited about it? What's happening right now? But we think this is very important and very important to add to the Pro Tip series. So we're just going to jump in with, you know, starting at one, what is insulin resistance in type one and what drives it? Let's talk about that first, make sure we understand awesome.

Jennifer Smith, CDE 02:54 So I think it's important to again, define kind of insulin resistance as what's happening in the body? Like, why are you using a ton of insulin? That's what I think most people on a very like, just low statement level, I use a lot of insulin. I must have insulin resistance. That's not necessarily true, and I think that begs definition as well. Overall, the definition of insulin resistance is the body is impaired in response by some specific tissues in the body to actually using insulin, well, which then decreases glucose uptake or movement of glucose out of your bloodstream into those cells, right? And the main sort of tissue receptors for insulin that become resistant are your liver cells, your skeletal cells, and then your fat cells. You might also see them called adipose tissue, but it's just fat cells, essentially, and it really means that your body just isn't it's not allowing the insulin to open the doors on those cells and allow the glucose to come in so our body doesn't essentially dispose of glucose the right way. I mean, it's the defining piece of type two diabetes. And while we really want to talk about type one, I think that's the piece that is misunderstood, because it's happening in type one and type two in a in the same way, but potentially and potentially for some of the similar reasons, right? But type two, we may eventually get to insulin resistance by not really seeing blood sugar changes, right? Because the body is actually trying to compensate for those cells not using insulin. Well, the beta cells just put out more and put out more and put out more insulin, and eventually they kind of get pooped out, right? So in type one, I think it's important to then define we can have insulin resistance in type one, but there might also be times where insulin. Needs are very high. And that doesn't mean you have insulin resistance that is long term a problem, right? So to defining those time periods really insulin resistance for time specific could be puberty, your child or teenager may use an excessive amount of insulin because there is a lot of growth and a lot of stuff happening. But unless your child is also obese, has elevated blood pressure issues, has issues which with low HDL levels, kind of the metabolic pieces that we're looking for that coincide with insulin resistance or metabolic syndrome, right? You may just need more insulin steroid use. You need a lot of insulin for using steroids and some other medications or other medical treatments. You may have excessive use of insulin, but there's the resistance in the picture, then, because of something that will not be long term, okay? Does that make sense? And you type, you know, pregnancy with diabetes as well, gestational diabetes, those are all instances of insulin resistance that they can be managed. And once those hormonal shifts are out of the picture, the resistance typically isn't as excessive or and, or just goes away, right? It

Scott Benner 06:19 could be language with type ones too, because, like you said, insulin resistance is a very specific thing, but you could be at times resistant to insulin. That's the feeling right, like it doesn't matter how much insulin I give myself, it's not moving. I'm resistant to the insulin. I'm insulin resistance. And then those two things just get blended right together, correct? That's just Yeah. And now it all means the same thing, but it doesn't mean the same thing. Does not again, weight gain, sedentary lifestyle, hormonal changes, medications, illness or stress, lack of sleep. These are all reasons why you might find yourself requiring more insulin than you normally do, right? Doesn't necessarily mean well, the weight gain does, though, right now weight gain is that would be insulin resistance.

Jennifer Smith, CDE 07:04 It would be especially if it's weight gain that goes well outside of a growth parameter, or expected growth, right? Kids, teenagers, we expect them to grow, and usually growth happens in weight and then height, and then weight and then height, right? It doesn't typically all happen at the same time, give or take the kid, right? But we wouldn't expect a child to grow really, really slow or not much in height, but continue to pack on the pounds. That's not what we would want to be happening. That's not normal growth. And so then if other parameters are in the picture, especially, you know, more sedentary lifestyle. I there is, you know, one of the potential risk factors when we talk about type one with insulin resistance is a family history of type two. So there's the potential, then, that the body is more from a genetic predisposition to have the potential for problems with weight management and whatever. And again, there are people that would beg to differ with that, but there's enough research out there. I've

Scott Benner 08:07 had a doctor on from Joslyn. He's also on staff at Harvard, and he said that, you know, the term double diabetes is just, you know, going to take on more and more prevalence, maybe in the zeitgeist coming up, probably because of how glps are working. For some people with type one, which then, you know, you ever see somebody with type one, go, I tried a GLP. It didn't do anything for me. And I thought, oh, yeah, you don't have any insulin resistance, you know what I mean?

Jennifer Smith, CDE 08:33 And or the other factors that the GLP ones, I mean, they're, they've been used for a long time. The newer versions now are definitely like the steroid version of what we had years ago that really didn't do what the new ones are doing.

Scott Benner 08:46 Glps on steroids, right? I mean that inflammation, weight loss, it tamps down hormonal issues for some people, also just constantly high blood glucose, just chronic hyperglycemia, can increase your insulin sensitivity. You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to set it up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works. And I picked it up. I was like, hello, and it was just the recording was like, us. Med doesn't actually sound like that, but you know what I'm saying. It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your order's ready. You want us to send it? Push this button if you want us to send it, or if you'd like to wait, I think it lets you put it off, like a couple of weeks, or push this button for that, that's pretty much it. I push the button to send it, and a few days later, box right at my door. That's it. Us, med.com/juice, box, or call 888-721-1514, get your free benefits check now and get. Started with us, med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new eyelet pump. Check them out now at us, med.com/juice, box, or by calling 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox podcast.com to us Med and to all the sponsors. Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system. The mini med 780 G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings, without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about Medtronic extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how you can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox

Jennifer Smith, CDE 11:31 it can actually, yeah, it can increase high blood sugars. Can increase your insulin needs, not your sensitivity, but yeah, exactly, it can

Scott Benner 11:39 give you increased insulin resistance, is what I meant,

Jennifer Smith, CDE 11:41 right? Absolutely. And what, what does that boil down to? It boils down to an inflammatory, you know, nature. I mean, we've talked before when we've talked about the different things that high blood sugars do in the body, right? And it is. It's kind of like, I think you've said, like a sand blaster to the outside of a painted building, right? The more sugar you have circulating, the more damage it creates inside your vessels and your tissues, thus all of the complications that we know about and have been told about, but if we leave that high, it's just chronic inflammation, and that's really hard for the body to get over. I think it's interesting that the doctor you talked to actually commented on what we kind of call now we're really aiming for the ability to have a dual diagnosis. And there is now in the ADAs, I think I brought this up before too, like an 88 standard changeover, the 2025 standards of care in diabetes does have a specific kind of statement within their document that notes that although type one is the diagnosis, some people with type mate one may have features that are associated with type two, things like insulin resistance, the obesity factor, metabolic abnormalities, inclusive of things like PCOS and all of those, and in terms of managing their life the best that we can, we're going to need to create a category for those people who have features of both type one and type two, almost a new diagnostic code or a new not just type one or type two or Lata or type 3c, or, You know, any of those things, but it translates then into the ability to access medications that can be an advantage. And as of yet, we still don't have any. We don't really have anything that's type one outside of insulin. And maybe, you know,

Scott Benner 13:36 my daughter's endocrinologist gave her a double diagnosis, and it was accepted by our insurance the first time. She didn't have to argue about it.

Jennifer Smith, CDE 13:44 And there are some specific parameters, like, if you're looking at that dual diagnosis, because you've gone through it with your doctor, it's not just your, you know, Google searching, or whatever it's you've gone through it with your doctor, and you've got at least, I think it, think it requires at least three specific areas to be check off points of determining insulin resistance. It it's based on how many units of insulin per kilogram of body weight you're using in a total daily amount of insulin. If it's over that amount, check box, right? Obesity is another indicator, right? So if you're looking at BMI from that indication, the threshold for the GLP ones is at least a BMI of 27 and above, right? So if you've got those factors, blood pressure that's elevated more than 130 over 80, I think it's a HDL that's low, especially for for men and for women, you've got high triglycerides higher than 150 all of these are their check offs to proving that there's a metabolic condition or a metabolic piece despite the initial diagnosis of type one, that dual diagnosis can be really beneficial.

Scott Benner 14:55 I know for sure, after talking to Dr Hamdy, I'm gonna have to be digging more into what a cytokine is, because. Because he kept bringing it up a lot. He also talked about a oral GLP medication that's in the pipeline that will not only help you with weight loss, but minimize muscle loss. So very he was very excited about that, I will say, he seemed very sure that injectable glps are a flash in the pan, and that the oral ones will be the way it happens much sooner than you expect. So I have my fingers crossed for that. I wonder,

Jennifer Smith, CDE 15:27 did he comment anything about the reasoning? I know a lot of people have asked for a long time about, why can't we just take an insulin pill? Right? And it has relevance to what the digestive system does to that it just breaks it down, and it digests it, and you really get nothing out of it. Then, right? So either it's an injectable or it's an inhalable and then the body doesn't break it down too quickly, and you get nothing out of it, right? He

Scott Benner 15:53 didn't mention how it's getting accomplished at this point, but if people are interested, it's episode 1411 it's called GLP essentials, with Dr Hamdy is very thoughtful on the subject. I'll have to listen to that too. Yeah, very involved for a long time. Hey, I just want to say that if you have type one and you're not experiencing what seems like actual insulin resistance, some reasons might be genetics. You may have, like Jenny said, not be in one of those hormonal impact signs. You could be younger because, for reasons, you know, younger people don't experience it always as as frequently as older people, and you might just be more active, like, you know, we talk about that all the time the Pro Tip series and other places. Why do people struggle with a ID systems? Sometimes, because I'm super active on the weekend, but not during the week or vice versa. And you're like, oh, this thing can't keep up with me. But the truth is, is that your lifestyle is greatly impacting your insulin needs, correct? Yeah. So that's another way to think about it,

Jennifer Smith, CDE 16:50 and therein lies a you then don't really, you're not really classifying that as insulin resistance. That's a lifestyle impact or unlike chronic inflammation, which can also come from other health conditions, they could be impacting your body's ability to use insulin the right way or efficiently. And so then inflammation is more of a long duration, and you are likely to then have true insulin resistance, whereas high blood sugar is from a really stressful job. I have so many you know now working with a lot of women who are kind of moving past menopause, moving into sort of retirement stages, right? What we see is really high stress, high energy jobs. They retire, and come January, they're like, I don't know, I'm low all the time, like, well, let's take a look.

Scott Benner 17:41 I would curse right now and tell you that Arden's been off of school for a number of weeks. Might be six, eight weeks, she takes a GLP medication that helps with her insulin. You know, resistance, because she probably has PCOS. And you know, her settings are much lower right now than they were back in college. And today, she went back for just a day, like, to go back for a day to do this thing. And since she woke up, and now three hours later, her blood sugar is 175 like the algorithm, can't it. Can't get her down, like, because now our settings are for Arden at home, not stressed out. Arden, not Arden's at school, thinking about all the things she has to do art. And knowing

Jennifer Smith, CDE 18:21 the algorithm you're using, I know that it takes a little bit of adapting to actually, yeah, nudge it back, yeah.

Scott Benner 18:27 It'll keep up a little bit eventually. But the truth is, is that the person she was on her graph yesterday and for eight weeks prior to that is not the person she is today. So, and I'm telling you, that's exactly what it's from anxiety life, you know, foot on the floor, that doesn't go away. Basically,

Jennifer Smith, CDE 18:45 kind of going back to the doctor's comments about the cytokines you're like, I have to look that up. There's a lot of really good cellular investigation as to insulin resistance and what's not happening right in the body, and what are some of the lifestyle things that we can get to beyond adding extra medications that could, you know, again, help. So I don't

Scott Benner 19:15 want to get into it now, because we'll get off track. But he had an interesting take that I'll share with you privately, and people can go check on it, the livers role in insulin resistance. So how could the liver be impacting people? Yeah, I mean,

Jennifer Smith, CDE 19:31 you know, your liver is a really interesting organ, right? What the liver does a lot of things. It's a detoxifier. It helps with management, not only of blood sugar, but a lot of other systems in the body. And so if your body isn't using insulin the right way, there's a disconnect to the liver. For you know, ease of explanation, there's a disconnect to the liver, then about what it's supposed to do for. You and it gets off balance. That's the best way to really, you know, simplify it overall.

Scott Benner 20:04 So I have a little bit of language here. I want to know how you feel about this. Under normal circumstances, insulin suppresses the liver release of glucose. When there's insulin resistance, the liver doesn't always receive the stop message, effectively Correct. That's what I said. It gets what you said, Okay? Because I was like, Oh God, I'm not sure if I'm understanding, nope. So I just wanted to make sure. Okay, awesome. Moving on. Because these are also, I should point out, these are questions that were sent in by listeners specifically about insulin resistance. Oh,

Jennifer Smith, CDE 20:33 awesome. Well, they were very well thought questions, honestly, very well worded and well put together. If you really wanted to get into the science of the liver and all the things we could use big, fancy words, you know that talk all about glucose uptake and fatty acid oxidation and like all of these. But right? People are gonna be like, I don't know what that word means. Like, what does that have? I don't understand. Just tell me why my liver isn't doing the right thing,

Scott Benner 21:00 doing the right thing. How does insulin resistance impact long term diabetes management beyond just needing more insulin? Are there complications that are associated with it? That was the question that we got from a person. What do you think? I think

Jennifer Smith, CDE 21:15 the deeper question is, with insulin resistance, it creates a problem with overall glucose management, that's the bottom line. And so really the question there is, if I don't get on top of the resistance, meaning really, I'm not managing my blood sugars because I'm not able to get my insulin to work, well, down the road, you have all of those long term complications that we're really trying to prevent, right? And the biggest ones really being heart conditions and those micro vascular things like in your eyes and the nerve cells and all of those things are relative to the bottom line being your blood sugar management. But if you're doing the best that you can, and you're using a lot of insulin, it's not quite controlling everything yet, then the real issues with resistance are the downline of what does that mean with blood sugar?

Scott Benner 22:12 It's funny, as I thought about this one, what popped into my head was a well maintained classic car. It's gonna sound strange for a second. But I have a friend who drove a Camaro, you know, built in the 60s. Not just beautiful car, but like original three speed transmission, 326 motor. It was convertible, had the headlights that uncovered and like the covers, came off and slid into the car, all run by air. And 4050, years later, the car looked brand new and worked brand new, and it made me think about people who say, I'm fine. Like, look at me. I have type one diabetes. But, like, I know you're saying my a 1c should be this, or my variability should be more like this, or maybe I should eat like this or that, but I'm okay. And to them, I would say that in 1965 that car looked brand new, and the reason it still looks brand new is because of the meticulous way he took care of all the little parts and features of it that you don't recognize are even happening day to day. Like, yeah, I know this is an old timey idea, but there's a big piece of plastic that like, flipped out and slid into the car, all off of air pressure that still worked. 50 years later, you have little functions inside of your body like that, and they're just really important to keep up. And so if you're wondering why, sometimes you buy a car, and 15 years later, it's garbage and you basically throw it away, it's because you ignored some of the little things that day to day seemed like they were okay, but could have used a little tender, loving care. So

Jennifer Smith, CDE 23:40 you made me think of my dad. He and honestly, I It's like you were talking about him truly, because he had a 68 Camaro. Oh, no kidding, dad. I should say it's actually my brothers now. I mean, my dad's been passed away for a number of years already, but he willed it to my brother, so my brother now is the one who maintains it. And you're right. I mean, my dad, if anything I learned from him beyond just exercise, it was you take meticulous care of the things that you really want to last. That was his bottom line. I mean, he waxed our bicycles. Scott, so it sounds like the same guy you're talking about, like all the care that you give, but you have to think about yourself. It's like the advice that's often given to parents. If you have a child you're taking care of you have to take care of yourself too, or you're not going to be there to take care of those who need you, right?

Scott Benner 24:31 My friend eventually sold his car. Oh, that he bought from the first owner, which was an old lady who literally, just like the story goes, like, put it in the paper. And he got there, and she's like, I can't handle this thing anymore. And he bought it for $2,000 and sold it many decades later for $60,000 and I think if you want to still be valuable many decades from now, you gotta polish the chrome a little bit. You know what I mean. And that's not a euphemism. Yeah. But no, not

Jennifer Smith, CDE 25:00 at all. If you want yourselves to be as healthy and lovely and at 90, you want to grocery shop and carry your bags in the house and all of the things there's maintenance to your body, you have to do, right?

Scott Benner 25:11 Yeah. I mean, it's the difference between whether you go to the junkyard at the end or you gracefully, you know, drift off. Here's another question for people, many type one struggle with unexplained high blood sugars despite pre bolusing and adjusting insulin. How can someone tell if this is insulin resistance playing a role? I think this gets into management. I think this is more about settings, right?

Jennifer Smith, CDE 25:34 I do and because I think the question just begs more discussion, really, it does, because it's not defining all the time. I sit high. No matter how much insulin I dump in, I sit high. It's specifically around meals and going high. And so with the idea that this person feels like their Pre Bolus has been worked on, and that that's potentially not the issue, then maybe there are there some some other components within the meal time and or maybe the ratio has changed, right? Maybe they've grown. Maybe they've gone through a life change of some kind, and so maybe the ratio has changed, but they haven't changed that. They've just been playing with the Pre Bolus.

Scott Benner 26:13 I tell people all the time, because people all the time say, I don't know what's going on. My Pre Bolus time is 30 minutes. I have to Pre Bolus an hour before I eat. I'm like, well, that's not a Pre Bolus issue. Like, that's something else. So I always tell them to go back to the beginning make sure the basal is okay. Yep. You know, has anything huge changed in your life about your activity? You know, the things you're eating, right? That kind of stuff, you're sleeping, etc, essentially,

Jennifer Smith, CDE 26:36 the variables, that's what you're you know, I mean, looking at at those variables. Maybe the person was used to walking their dog three miles in the morning before they actually got to breakfast, and that was a benefit, and now all of a sudden, they're not doing that. Or you know what I mean? So absolutely. So

Scott Benner 26:54 I'm going to read now five questions in a row that are all part of a bigger conversation. Okay, there seems to be two schools of thought, one focusing on low fat, high carb diets, like the mastering diabetes diet, and another one, low carb approach. What does the research say about the best dietary approaches to improve insulin sensitivity in type ones? The next question is, are there specific foods or micronutrient ratios that have been shown to improve insulin sensitivity. The next one is for someone who's insulin resistant. Should they be focusing on cutting carbs, reducing fats, or prioritizing protein? And there are mixed opinions on intermittent fasting. Can fasting improve insulin sensitivity type one diabetes, or does it pose a risk? I'm going to throw in this one as well. Some people say that processed foods contribute to insulin resistance, what specifically in processed foods makes them problematic for blood sugar control. So we'll go through them one at a time, but I think they're all part of this conversation. They are,

Jennifer Smith, CDE 27:54 and I think we'll, we'll kind of mush them together, even though trying to kind of go through them separately, it's probably going to answer

Scott Benner 28:02 a lap, yeah, they're gonna go for a lap, yeah, yeah. The first one is the tough one, because, you know, people who are very strictly low carb, that have a lot of success with it are just going to tell you, you know, love, like, what do they say? Low numbers, right? You know, little bit of

Jennifer Smith, CDE 28:18 car, the rule of the rule of small numbers, right? A little bit of carb, a tiny amount of insulin, you've got an easier, kind of a little easier control mechanism, because there's not as much overage there from an insulin, but you also don't have a heavy hitting macro nutrient being carbohydrate that you're really trying to step on top of and keep managed. Right? The big thing behind this main question of the two schools of thought from a dietary standpoint, or like my background, it really boils down to looking at what each of these fueling plans provides. Has science that does suggest it can work. They both do the vegan, low fat diet, plant based absolutely has research that suggests you can reduce insulin resistance, you can bring your medications down, you can help to control the heart issues, even things like PCOS end up being better managed and navigated. Weight loss is something that happens in the picture. Those are 100% the same thing that the low carb approach also is able to prove that they can achieve, you know. But the bottom line is, you decide on it, and you don't falter from the plan. That is it in a bottom line picture. If you're going to do something like all plant based, low fat, then do it. Figure out. But you have to stick with it. It doesn't mean every week you will go out for your 16 ounce steak, because you can't 100% give that up. This is a plan, right? You choose it, you follow it, and 100% Your metabolic things, they clear up. They do the cholesterol levels, the blood pressure issues, again, even the metabolic things, the way that your body cells use food, they are changed. Yeah,

Scott Benner 30:12 I think it's, it's such an important thing to say, because I think that's probably where people go wrong. They're like, they dive in, like, you know, I'll eat super low carb. But then on Saturday, you have a slice of pizza with a bag of Cheetos, and forget, right? Two steps forward, one step back. It was probably two steps forward, 10 steps back, right? It's about whether or not you can really commit to it. You think I

Jennifer Smith, CDE 30:33 really do? Because there is when I look at the data, and people ask me the questions all the time, well, should I should I go this way? Should I go that way? I have to say. But what? What do you know about both of those plans? They're almost like opposite ends of the spectrum. Yeah, which one are you most likely to be able to stick with long term? Because if you can, here are the 10 different research articles I can give you. They're not even based in, like, the big ones that a lot of people have problems, like believing in, right? These are really good, defined references that suggest it can work. And we've got communities that are centered on both of them with discussion about why they work, and all the people that that they definitely help. Right?

Scott Benner 31:19 Is there any scenario where following any of these ideas strictly won't work for somebody? Is there somebody who's just genetically it doesn't work for is that not a thing? Because it's part of the little questions? Question, yeah, like, I mean, is there someone out there just eating low carb exactly the right way? And they're like, how come this isn't working for me or vice because I've heard it for the more the vegetable, like fat one. I've heard people say I've done it specifically well, and it hasn't worked for me, but I'm watching other people do it, and there's got to be something there that's, I'm

Jennifer Smith, CDE 31:49 sure that there is. And so that also suggests that maybe either you're not following it to a T so really, get the reference materials. Get the books. I mean, there's, there are books on, you know, the mastering diabetes and also on the low carb end of every their books that definitely give you very well defined this is your plan of action. Yeah, you haven't quite done and you've really only been following with some online person who tells you what they're doing. Maybe there's a little piece in there that's not quite what your body is working with. The best way

Scott Benner 32:19 that takes me to the micronutrient idea. Like, how would an average person who's like, I'm going to make sure I'm giving my body exactly what my body needs? Like, how do they figure that out and put that into play? Yeah? I mean,

Jennifer Smith, CDE 32:30 it also goes into lifestyle, right? If you are somebody who has a really excessive amount of movement in your life compared to somebody who is more sedentary, we would look at what is your overall need to be able to break down macronutrients. And then the lovely thing about the macronutrients is that if you are getting a fair variety of foods, you're going to take in all the micronutrients that you need, both the fat soluble and the water soluble vitamins, the antioxidants, all those things that help on a cellular level, change things like inflammation. It's not as simple as people often think, cleaning up the diet, yeah, just

Scott Benner 33:11 pouring in the right stuff, yeah. I mean,

Jennifer Smith, CDE 33:13 it really does behoove people to sit down with somebody knowledgeable, and I'm not going to say that, you know, find the right person right away. It might take, just like looking for the right endocrinologist. It might take a little bit of navigating through some people to find somebody who kind of fits with you and that you can work really well with, but they should be evaluating your life, what type of stressors you have, what kind of energy level or exercise plan do you have, and then building into that well to meet your need as well as address this insulin resistance and overall help with insulin sensitivity. Let's play with adding this, taking this away, cutting back here, adding this in. You know, somebody who is an endurance athlete is going to have a different macronutrient need profile than somebody who is in the lifting gym three hours every single day and they're bench pressing. I don't know a large amount of weight that I can't even probably live. Does that make sense, though it

Scott Benner 34:19 does. I want to go to intermittent fasting and then go back to processed foods. So the intermittent fasting, what I have here says that, you know, for some people, it might improve insulin sensitivity, but then it warns against hypoglycemia. But what I would say is, from my own personal experience with Arden, is Arden can fast almost for freaking ever, but she's also on an algorithm that's taking away your insulin at times. So if you're using, like, jacked up, heavy settings, and then all of a sudden, like, I'm gonna start intermittent fasting. I mean, you're probably gonna get low. But if your settings are there, and your system can bob and weave with the fact that there's nothing in there, I've seen art at night eat for 1824, hours. To not get low, like, as a matter of fact, like, I would tell you, if you can get all that straight, and you're a person who's like, oh, I can't exercise without getting low. Wake up in the morning, don't eat with great settings and single move workout in the morning. Yeah, so

Jennifer Smith, CDE 35:13 no, it's a, I think it's a quality question. Whoever asked about intermittent fasting, the risks, as you just said, can be minimized, especially with the type of technology that we have today. At it at our disposal, right? Not everybody, but a lot of, a lot of people have access to at least a CGM, great, right? If you have access to an A I D pump system, fantastic. That moves you up the mark to avoid risks if you're trying to do some fasting, but even those who do multiple daily injections, you can strategize your insulin and your dosing in order to be able to do intermittent fasting. And there are, you know, by definition, there are a lot of different kind of ways you can intermittently fast. Some people do fasting two days in a row, then they eat for two days and they fast for two days, right? Then there are people who do what's more common, and I think in terms of navigating the real metabolic reason, which I would encourage people to really look up, because it's quite fascinating the cellular level and the reasoning behind intermittent fasting and how it really benefits insulin sensitivity and weight management and everything. Is the idea of time periods of the day where you will designate, this is my eating time, yeah, and then time periods of the day where you will be done eating, let's say by 7pm and then you don't eat again until 10am the next day, right? Or noon the next day, and there are a lot, especially from a women's health perspective, there are a lot of good referenced research in what that does from a hormonal level in women's health. Not enough of it. I think that goes into real type one diabetes. But if you can read into the research, you can understand how it could impact your diabetes management, because most women complain about the fluctuations around their monthly cycle or moving into perimenopause or even menopause, right? And if we can harness that energy burning piece of our cells in the right way, and also clean up our intake with the food that we are eating. It makes an enormous difference on our overall ability to use insulin the way that we're supposed to. I'm going

Scott Benner 37:33 to jump to this last piece here, processed foods. You know, can processed foods really blah, blah, blah, like, I think, I think in the information age, we're very used to people saying things, and we just accept them, right? We don't really dig deeper into them. And so some people can also hear that in just this recording, like, oh, processed foods are bad for you. Like, ah, I've been eating it all my life. I'm fine. Like, it's great. Yeah, you're because your car is not 50 years old. Yeah, your body's still able to make it through a ho ho without you dying. But one day, you'll put the wrong gas in and it's just gonna shut off. But I'm gonna keep a lot of this for the nutrition series that you and I are gonna do, because I think we should do an entire episode on why exactly processed foods are doing what they're doing to you.

Jennifer Smith, CDE 38:14 Yes, it's on my list, and I have not organized for us yet, sorry. Give

Scott Benner 38:19 me a high level overview of processed foods and how they can, you know, make insulin resistance their car make it worse.

Jennifer Smith, CDE 38:26 Yeah, and actually, it ties into that first question in this little kind of segment that we're talking about is the focusing on either the really low fat high carb intake or the more low carb or ketogenic type of plan. One thing that's missing from both of those plans, for the most part, if you're doing the plans the right way, you are eating food that looks like food, what has that done then, behind the scenes, whether you're low carb, high carb, whatever you've cleaned out. I mean, the question here, what specifically in processed foods makes them problematic. Have you ever read the back of most of the packaged things that you buy? I mean, outside of maybe you bribe brown rice. It's brown rice, right? There's nothing problematic in that unless you're low carb, then you won't eat it. When you look at the back of many packaged items, they are full of things that I guarantee you can't pronounce, nor do you know where they came from. Why are they in there? Outside of things that have parentheses after them, since this anti caking agent or you're like, great, but why does it have to be in my food? Then, yes,

Scott Benner 39:35 it went your mouth and came out your butt. But it does. You don't know what it was doing. What was in there. Maybe you could swallow stuck. You could swallow a nickel and it can come back out again. It doesn't mean you want it there. I'm just high level, rapid breakdown of refined carbohydrates, added sugars and metabolic overload, inflammation, oxidative stress, unhealthy fats interfering with insulin signaling, nutrient deficiencies and lack of fiber, chronic overeating and weight gain. Because of calorie density and hormonal dysregulation, on and on and on. Like, yes, processed foods are bad for you, but we'll dig in later about why. And yes, they can listen, if you just ate food that you, like, Jenny just said, like, you lift it up and go, this is broccoli. I see chicken like, you know, and yeah, then eat it right. Don't take the chicken and dump some sauce on it that you bought from somewhere and go look. It's orange chicken now. Now it's chicken with nickels all over it. Think of it that way.

Jennifer Smith, CDE 40:29 It's a good brain, like you're eating

Scott Benner 40:32 aluminum foil or whatever. Like, maybe it'll make it out. Maybe it won't. Right? Can we jump to how are you on time? You good? I have about five minutes. Okay, let's go to medication, supplements, options. What can people take? Type one to help with insulin resistance, if they've changed their diet, if they change their exercise, and it's just not working,

Jennifer Smith, CDE 40:54 sure? I mean, there are prescription meds, and again, early on, I talked about how you can potentially get that dual diagnosis to improve the ability to get these covered with really good, well written letters from your doctor, things like the GLP ones. GLP one gi P is things even like old school Metformin is another potential one that you do not need a prescription for, and I can definitely say is visibly beneficial, not to the impact of things like a GLP one, but definitely beneficial in the here and now, because it gets used up pretty quick, is the Berberine that is definitely one that is beneficial. It helps attack kind of around that meal, but not necessarily long term, okay, right? Thank

Scott Benner 41:38 you for doing this with me. That's a great topic. Now it's awesome. I'm going to send all the information over to you, and we'll you know, so we have everything for next time. But before we go, how does hydration impact insulin sensitivity?

Jennifer Smith, CDE 41:52 That's a really simple one, right? Because if you are not well hydrated, all the things that are circulating in your system that are supposed to get to the cells to allow them to work the right way, one of them being hydration. If you are dehydrated, it's like moving mud or molasses through your system instead of like water out of a faucet, right? It's supposed to fluidly flow at your cells are supposed to have access float around in your body, kind of like, you know, really low leveling biology explanation. But hydration is huge, and hydration, along with which, I think often gets missed, people say, okay, they told me to drink more water. I'm drinking more water. I'm drinking like, two gallons of water a day, great, but now you're probably flushing out a lot of good electrolytes. So there is a fine balance, I say, you know, easy, simple electrolytes on a day to day basis with your water intake, are also very valuable from a balance of things in your body, you know, and the eight cups a day, give or take the person, it's probably more. If you're an athlete, it's probably more. If you're sitting in sauna for three hours a day, right? Based on size person athletics, you can kind of go up and down from there, but if you're going to try a baseline, great, stick with the eight.

Scott Benner 43:13 And what about anybody who's going to say, I'm incredibly well hydrated. I had two liters of Diet Coke today, same thing as two liters. No, okay, not at all. No, not, not at all. There is drink juice boxes all day. No, no,

Jennifer Smith, CDE 43:28 not. Hydration. Okay, are you sure? Let's look at let's look at water. Water is hydrating. There's nothing wrong with it. Just

Scott Benner 43:38 drink some water. Okay, what if I take water and I put something in it back in the day when I was a kid, but Crystal Light, I don't even that exists anymore. Now I put Crystal Light in it. Am I still drinking water? Or am I am I negating the benefits you're still

Jennifer Smith, CDE 43:50 definitely drinking water? Again, that goes back to processed foods, and what is in the thing that you're adding to your water to make it taste like you want to be able to actually drink the two gallons of water a day,

Scott Benner 44:02 Crystal Light Water with three nickels, yes, at least you're getting water. Hopefully they won't grab onto an artery on their way through, or whatever. I know arteries are not in your digestive system. I'm just saying no. Okay. What are your thoughts on supplements like Berberine, Metformin or a GLP like ozempic or Manjaro for addressing insulin resistance in type ones. That's a question right from a listener.

Jennifer Smith, CDE 44:24 No, I think it's great. I also think it needs to be differentiated, right? Because a supplement is something that isn't technically regulated, at least not most of the time, versus a medication that has approval, is on the market, is available through prescription. Like, you can't get it otherwise, right? So when you talk about things like Metformin or the GLP ones, GLP one Gi, P, the Metformin is a little bit different, but all of those are prescription you talk about Berberine or some of the other ones. Like, I mean, there are a whole list. Of things that help, from the standpoint of even optimizing your own GLP one system output, right? Your gut output which isn't working, which is why the GLP one meds do work in people with diabetes. So there are a whole host of those. I once

Scott Benner 45:16 got listeners to send me all the supplements that they take. And I thought just like, tell every like, let them just tell me everything that they take, and I'll weed through it. Maybe I'll find some like thing, and I can't figure out a way to be certain about any of it. And so like, you know, it's hard to just jump on here and start saying, like, you should try this or that, or this lady said this helped her. And part of me wants to put it out there so people can decide for themselves. And part of me is like, God, stuff could be expensive and maybe not do anything. And, you know, and many

Jennifer Smith, CDE 45:44 of them are, many of the supplements are, but you also with anything, I think, even with the prescription meds, you should be doing a little bit of your own research. Yeah, you should be doing information searching, because many of the supplements do have good research backing to them, but the information is important to look at, what was the population that was tested most often for some of the supplements we're looking at tests being done mostly in type two diabetes. Does that mean it's not relevant to type one? Not at all, but they're really only doing most of this stuff in type two, and then what's the concentration that's being used? What's the healthy concentration to use that you can get on the market? You already said, what's the cost of using that? What impact should I see? And a lot of people, I think, with supplements, to go down that kind of road, first is you end up getting a list of six things. And you think, Well, great. All of these are supposed to be wonderful for my weight and for my blood sugar and for my my gut health. I'm just going to throw them all together and see what works. Well, if it does, fantastic. But some of them may not be doing much at all, purple, right?

Scott Benner 46:59 Five at once, if they all so then I think the problem becomes then, because I've gone through this myself or with people in my family, you say to somebody like, look, we're just going to take one of these a day for three months and like, and people are just like, What are you kidding me? And if you don't see a pretty instantaneous like, change or value, it's hard to remember to even do it. It's hard to Shell out the money. And then people tell you what's got to be a quality, you know. And then you look and quality means $40 for a jug of them, and you're like, oh, you know. And so I don't know how to talk about, I wish there was, like, an easier way now what I can tell you about, what I've learned about glps Over the last couple of years, taking them for myself, using them for my daughter with type one. Listen, I'm not obviously a doctor or researcher anything like that, but I know a few things to be true after the last couple of years, if you're using a GLP medication, as Dr Hamdy said in Episode 1411 and you are not doing muscle training and taking in enough protein, he says you should not even be using them. It's just too dangerous to lose muscle, especially as you get older, and it's just something you don't get back. So you have to maintain and build muscle while you're using a GLP. It's very important. The other thing I've learned is some type ones are like, Oh my god, I jumped on a GLP and it changed my life. Like, I use significantly less insulin. I like, you know, my spikes are lower. Like, oh, all these good things are coming. Then another type one will say, I tried it, and honestly, I tolerated it well, but nothing happened to my insulin needs. And I guess I've come to believe that some people can have, you know, what I've heard called, like, double diabetes, like they have type one diabetes, but they also have insulin resistance. Correct the dual diagnosis, yeah, without type one, they'd still have insulin resistance. And I don't know if I'm right about that or not, but just watching people, it's the only like explanation I can come up with why some type ones would take it and have such a reduction in someone, and some type ones don't have any So, right? Yeah. I

Jennifer Smith, CDE 48:56 mean, this actually gets into, I think, another, another question somebody had asked within the same line of questions, it's about like lab values and testing for insulin resistance. So again, if you're looking at supplementation or pharmaceutical type of prescription, it would behoove you to know is what I'm seeing growth in my teenager and they just need more insulin? Or is this truly insulin resistance? Because there are some markers that you could look at that could move you to a diagnosis and again, now with ADA standards, suggesting that people with type one could have these other pieces that are more type two, and so you could have a dual diagnosis, making it quote, unquote easier to potentially get the prescription option

Scott Benner 49:48 right, right. I'll mention too in that episode that Dr Hamdy, who is, I think, on the the arrows tip on this stuff, says that he thinks double diagnoses will be actually common. And acceptable very soon. So I it sounds like behind the scenes, the people who push for this stuff are pushing for that.

Jennifer Smith, CDE 50:06 And it sounds correct, given all of the information that we have and some of the newer, like real research that we are looking at coming from use in type one specifically. And hopefully that's a turnaround for prescribing and not having to sit to get six letters of approval from your doctor stating this, this and this are the issues. Why won't you approve this? But

Scott Benner 50:31 if you saw a type one like you see type ones who use glps, right?

Jennifer Smith, CDE 50:36 100% yes, not 100% of them. But yes,

Scott Benner 50:39 absolutely so. If people are interested in learning more, they should talk to doctors. And if you can't, I'll tell you this, if you can find a doctor great that understands it, but if you find one that doesn't seem to understand it at all, like look around a little more, because they're just going to throw their hands up and go, I don't think you should do that, which I think is code for, I don't know what I'm talking about, and I don't want to get involved. So right, yeah. Speaking, yeah. Many people say that losing weight improves insulin resistance. Is this true even in a person with type one diabetes is not overweight, even if the person is not overweight. So if we have a person with type one who doesn't I don't know score as overweight, could losing some weight help their insulin resistance? It could. I want to say that I think there are a number of things happening. I'm going to go back to glps for a second, even though we're not talking about them when they first came out. And I had a bunch of conversations with a bunch of different doctors, they would all just harp on the idea that people are using less insulin because they've lost body weight. And they would just keep saying that, keep saying that. And I mean, after having enough conversations, even like with Arden who did not have like, you would never have looked at Arden and thought like, Oh, that girl should lose weight, but she did lose weight, and that's part of why her insulin needs went down. I believe they just are

Jennifer Smith, CDE 51:52 besides the true effect outside of weight loss, the true effect of GLP ones is it goes beyond just loss, and that's the reason that somebody who doesn't have a weight based issue but has high insulin needs, if something else hasn't been identified, such as a normal weight person, lifestyle doesn't suggest that they should be using as much insulin as they actually are. It's very difficult for them to control their blood sugars in the after meal time period, then we're looking for things like PCOS. Is there an undiagnosed thyroid disorder in the picture? Right? I mean, there are, there are pieces that I see over and over. They stand out to me. As soon as I talk to somebody, I'm like, have you had this checked? Did somebody ask you about this? Did you get No, nobody's what is that? Nobody's ever mentioned that. I'm like, let's get these checked first. So

Scott Benner 52:42 if you lost a lot of body fat and your insulin resistance didn't change, then look for other impactors. But in a lot of cases, losing that body fat should change your insulin resistance. It should. What about other body composition ideas like, what about adding muscle? Would that help? It should. Is that because you added muscle, or because adding muscle reduced fat? Well,

Jennifer Smith, CDE 53:04 you can add muscle and still retain fat, right? I mean, fat is stored energy, right? I mean, we have a lot of stored energy in our body.

Scott Benner 53:11 So if I'm like one of those guys that, like lifts tires and throws them over walls, like, for example, I was just that size, but not that strong, had insulin resistance, and added that muscle, I could see a reduced impact.

Jennifer Smith, CDE 53:23 You could see exactly because, again, muscle is it's harder for your body to keep healthy to maintain. So the more muscle you have on your body, the more revved up your metabolism is. And that's kind of the like the baseline explanation to that, right? But that's essentially what happens. And we know that when we move our body, even people with insulin resistance, can say, I can take a walk, and I can see the impact of that. I can move my body, and I can see that my insulin does start to work better, probably not as good as if they were a lower weight, brought their, you know, brought their body weight down, or somebody of the same height, but a leaner body type with more muscle on it, but they're still going to see impact. So if you now lose weight, add muscle, and you maintain a movement, you're definitely going to see an improved a lower amount of insulin that you need. So

Scott Benner 54:16 I'm looking at all of the questions that led us to this bigger idea, and I moved to say there's a person here asking, How much does walking after a meal impact insulin sensitivity? He's had this long conversation privately with somebody I've known for a long time who has type one, and he's in his 20s, and has recently put on a bunch of muscles, started doing like jiu jitsu and stuff like that, and and went to a little more of a lower carb lifestyle, but everything's a mess because his job is very active, right? And he's on Omnipod five, and he's like, I am getting low every day at work. Like, I'm low constantly, like, blah, blah, blah, like, on and on. And I we just kept talking and talking and talking and the the first two things I. Said to him, I ended up going, No, no, no, not that. And then eventually I said, here's what we're gonna do. And I figured out that he was getting low after meals, and that seemed to be the biggest problem, but he was so sure about his insulin to carb ratio, he said it was one to 10. And I said, Listen, let's just make it one to 20. And, like, see what happens. And I got a text the next day. I didn't go under 100 and my spike was only, like, 160 I said, Okay, make it one to 18 tomorrow. Like, keep changing that until we get there. I think that was your problem. But what he was seeing was, is that he was eating and then he was going to work and walking, walking, walking and tanking every time if he didn't walk after he ate, it wasn't nearly the same. So, right? What's the functionality there?

Jennifer Smith, CDE 55:46 Right? Any activity Walking is one of the best. In fact, years ago, during diabetes month, I can't remember what organization they used to have, something called the Big Blue Test, Manny. Would say, who was Manny? Yeah, it was Manny. It was essentially check your blood sugar. Go do 15 minutes of movement, come back and check your blood sugar. And 99.9% of the time, you're going to see movement down in your blood sugar. I don't care what body size or type you are, you're going to see why, because muscles require energy to move, and we know that exercise is, I call it free insulin, right? Your body needs the energy it's moving faster than it normally is. Your muscles are now primed. The doors on those muscles are now they're more free to open at will, and they don't need as much insulin to unlock the doors and let the glucose flow in.

Scott Benner 56:39 We know that works. You and I know that works. Is that actually impacting your insulin resistance, or is it just changing the function of the insulin that's inside of you over and

Jennifer Smith, CDE 56:49 over exercise is going to at some level, it's going to impact your resistance, right? It is okay, but in some people that exercise every day, it's basically holding you at a level. If you stop doing that, you're going to climb in insulin resistance. It's holding you out of stability. The insulin resistance is still there. And if you are the type who needs the GLP, one type, or the Metformin or something to assist further, then all you're doing is holding things where they are with your exercise. Don't stop doing it. Keep doing it. But if you're not finding you're not reaching your goals of weight loss or post meal blood sugars or as much as you really want to, then you're looking at needing to add something to help the lifestyle stuff that you're trying so hard to do. Follow

Scott Benner 57:39 up questions from people is, how does muscle mass influence insulin resistance, which I feel like we just talked about. But can lifting weights really make a difference? Yes, right,

Jennifer Smith, CDE 57:47 it can. And weight lifting is interesting. It actually many people who lift weights find no change immediately in their blood sugar. In fact, those who really go to some of the more the boxes, right, the gyms that are just all lifting, you have your workout of the day. It's very resistance based. You might actually see a rise in

Scott Benner 58:07 your blood sugar right during the lifting itself. During the

Jennifer Smith, CDE 58:10 lifting itself, right? It's an adrenaline based kind of thing, sort of like a sprint runner. You might see from the adrenaline of a sprint or hill repeats going up and down. You're going to see a rise in your blood sugar. But in the aftermath, just like weight training, you're going to see that your muscles are now recouping. And in weight training, you're building the muscle that you broke down during the workout right to build that back up, your body needs to use energy so you become more insulin sensitive in the aftermath, if you do enough weight training or resistance training, lightweight to high weight, whatever is good for your body, what kind of muscle you want, you're going to see that retained long term. Okay, that's the benefit of daily exercise.

Scott Benner 58:55 Okay, all right, let's move to like beyond diet and exercise, hormones, stress, sleep, steroids, that kind of stuff. When people see a greater insulin need because they haven't slept enough, they're under stress, the doctor gave them a steroid for an infection or they have a hormonal impact. Are they seeing an actual change in their insulin resistance?

Jennifer Smith, CDE 59:16 It's momentary. I think, yeah. I think it's momentary. I think it's more right, right now, this is what's impacting my insulin. Need hormones in females, obviously, that's more in the moment, or depending on where they are in a monthly cycle can go up and down, right? Somebody who has a big business presentation to do, they may be stressed for a couple of days while they prep for it, and they plan it, and they work with their team, and then they get to it, and as soon as it's done, if you've changed your insulin doses to accommodate and keep your blood sugar managed, you're likely to need to remember what your doses were before the stress, right? Because it should come back down. That's momentary insulin resistance, which isn't, I wouldn't even. Call it resistance. It's just the effect of a variable here and now.

Scott Benner 1:00:04 Do thyroid issues impact insulin resistance? Yes, they do. Okay, absolutely. Hyper, hypo doesn't matter. They both

Jennifer Smith, CDE 1:00:11 have impact on your overall insulin need. Yes, both to the extreme of needing a lot more, as well as a they're both a little bit opposite. We actually see in hyper that because your metabolic rate and the turnover of all different types of medications is a lot faster, you're ending up needing you're clearing that, and you're needing to use a lot more insulin, right? Whereas in hypo, you've got metabolic slowdown until it's regulated. And so you might actually find that while your weight isn't being managed well, and that you feel like you need more insulin, sometimes there is dysregulation in dosing, because you feel like you're taking more but you end up with a lot more lows because of the lagging effect of the amount of insulin that you're taking. So there is, I mean, thyroid is, it's huge to get optimized if you're having issues with your insulin.

Scott Benner 1:01:06 Okay. Do you know how sleep impacts insulin resistance, like lack of sleep? You know the function of it, or just that it does. It's

Jennifer Smith, CDE 1:01:14 just, I mean, baseline is, it's, it's a stress, right? Especially quality sleep. You might have something that tells you you're sleeping seven or eight hours a night, but we have enough watches and Rings and Things now to take care of. Looking at what was our sleep quality light, how many times did we roll over in bed? Even some of these devices measure what would be like sleep apnea, kind of dysregulation of oxygen intake during the overnight times. You might think you're sleeping, but you're really not getting quality sleep through all of the different cycles of sleep, deep sleep, REM sleep, all of those things, right? And in the end, it again, is just baseline. It's stress on the body.

Scott Benner 1:01:57 Since you mentioned stress at the end, there's these like sub questions under our headings here, how do I manage stress to improve blood sugar control? I'm going to assume that me telling you to calm down is not going to help. I mean, is it just one of those things, like, you got to figure out how to manage your stress, really? What are you going to

Jennifer Smith, CDE 1:02:12 That's right? I mean, it's like a it's like a blanket statement, because I think everybody needs something that's going to be a little bit different to manage stress. I manage stress by working out. I run. I do yoga several times a week. There are different types of yoga, some as meditative. Some is more active yoga. I use weights. So exercise is really my like stress reducer. I also like to cook. So, you know, find your thing, and if that helps you, and you have time to build it in. It might be enough to keep your stress levels at bay. Some people stress, though, is not only their own life stress, but it includes their family's stresses, right? So then you have to navigate it all. Yeah,

Scott Benner 1:02:54 I noticed a hot shower makes hardness, blood sugar go down, and I know that it's, it's like, people are like, Oh, hot or cold or this. I'm like, I honestly just think she gets in there and she chills out, she sings and she relaxes. The water hits her head, and I think she just relaxes a little bit. So, okay, identifying, let's see IR insulin resistance on lab work and early warning signs. What labs or markers should someone ask their doctor about if they suspect that they have insulin resistance, and for those who don't realize they have it, what are the early warning signs to look out for? Are there lab value? Can I get there

Jennifer Smith, CDE 1:03:32 are like somebody, and this goes the route of really talking about maybe somebody who has some of the physical identifying markers like you're overweight, you have a more sedentary lifestyle, you may not have the cleanest food intake, maybe you don't work out those kinds of things. Are there markers that someone could be looking at with not knowing that you have diabetes? There are, I mean, obviously one test would be an A, 1c right? It's going to give an overall evaluation of is your body not regulating your glucose like it should in people who don't have type one, something like an overnight fasting insulin level, can also be a method of managing your body's output, and it's a way To sometimes also identify pre diabetes, before type two diabetes, because, again, early stages of type two, your body is over producing insulin to make up for that insulin resistance that's there. So that is another piece that could be managed. Obviously, somebody with type one doesn't need a fasting insulin.

Scott Benner 1:04:38 I went to our friend online to ask this one so fasting insulin, Homa IR, homeostatic model assessment of insulin resistance, a fasting blood glucose, hemoglobin, a 1c triglycerides to HDL ratio, a ratio higher than 2.5 to one is linked to insulin resistance. Your C peptide, of course, postprandial blood glucose. Insulin, checking glucose and insulin one to two hours after a meal could let you know if you have form of glucose metabolism and liver enzymes. Elevated levels may indicate fatty liver disease, commonly associated with insulin resistance. It says uric acid. High levels correlate with insulin resistance and metabolic dysfunction. Some early warning signs could be frequent, fatigue, increased hunger and cravings, difficulty losing weight, dark patches on the skin, skin tags, high blood pressure, brain fog, PCOS, dizziness or shakiness between meals, increased waist circumference. There you go. That's from

Jennifer Smith, CDE 1:05:36 our most of what's on my list. So you you got to all of that. Jenny's

Scott Benner 1:05:40 like, am I going to get supplanted by a prompt? I hope,

Jennifer Smith, CDE 1:05:46 I think it was a valuable question, honestly, because while some of these may not necessarily be in the realm of type one looking, some of them are even things like your cholesterol levels. I mean, the LDL especially, is one that we end up looking at your triglyceride levels, the relevance of the liver enzymes. All of those, whether or not you have diabetes, can be Hallmark identifiers for yes. It's

Scott Benner 1:06:13 funny, because I just had this thing I wanted to say, and then I looked down at the next question, and the next question encompasses the thing I wanted to say. So I was like, Wow, this must be building to the right place. I, honest to God, didn't know that this was about to happen. So this next bit is misconceptions, reframing frustrations, vetting information, and the questions that came in from people are, what are some common misconceptions that you hear from people with type one regarding insulin resistance? And I'm going to tell you that my question was, do you think we talk about insulin resistance correctly? Or do you think it's a catch all phrase that we use in a bunch of different places?

Jennifer Smith, CDE 1:06:47 I'm going to say that that this about insulin resistance, what we're putting together. I think it's really valuable, because I think we're defining the difference. But I do feel like it can be a catch all. It can be a place where, my goodness, this is a lot of insulin. Like I see a lot of questions often, like, my child, is this this age and uses this much insulin? How old is your child? Who's this age? How much insulin do they use? Right? And again, our insulin needs are our own insulin needs. They are how to know if it's resistance, I think we've defined quite well here. And when it's not, is it a time in life that there's a variable happening that's not resistance? It is the hit of what's happening right now? Yeah,

Scott Benner 1:07:35 I feel like there are sometimes where there's variables at play. There's sometimes where it's, you know, a steroid, or sometimes it's you just became sedentary, like your kid used to play soccer, and now they don't anymore, or you've got a job, or you're walking around all the time. Then on the weekends, you sit and watch football like whatever that thing is, no matter what, when someone needs more insulin, they're gonna say, I have insulin resistance, right? And I think the GLP conversation has shown me that some people just need more insulin. They're not necessarily insulin resistant, but at the same time, is that just a heady conversation between you and I That's meaningless to the end user who just either needs it or doesn't need it, right?

Jennifer Smith, CDE 1:08:12 Well, and I think to clarify, you need more insulin, what that says to me is without all of the other pieces that you think that you have insulin resistance. It really isn't. It boils down to have you looked at your setting, right if you're needing more around meals, but your overnight is sitting flat at 83 and you haven't really adjusted anything there, and there aren't any big pieces in the picture, and your hits are around meal times, probably not insulin resistant. You probably just need to navigate meal coverage. You

Scott Benner 1:08:43 might not be covering your carbs. Well, your ratio could be off, even if you are counting them correctly, or something like that. Yeah. In the end, I just want people to cover what they need, but I don't want them to ignore the other things that may be happening. Right? If it's as simple as taking an acetal to help with your PCOS and lowering your insulin needs. I don't want you just feeding the PCOS with a ton of insulin when this other thing could be valuable to you correct or something like that, or going for a walk or eating better, or that kind of thing, right? How does someone separate helpful advice from misinformation when it comes to insulin resistance? What do you think the misinformation is that they're getting like, maybe it's just the misunderstanding of the implications like we've been talking about. It's a vague question. It

Jennifer Smith, CDE 1:09:25 is a big question. Well, I think it boils down to you have to look at what your experiences are that's leading you to consider, is this resistance, or have I not considered what could be going on right now as a point in time adjustment that needs to be made, okay? Is it some of the things that we've already gone into? Are there lab values? Are there symptoms? Are there other things you know that you're looking at that are an issue that are leading you to consider some of the helpful advice? This is actually pointing you to think this is insulin resistance. I should get further checks or talk to somebody about this, or does none of the information that someone's bringing in fit what you're seeing? Does that right? Does that make sense?

Scott Benner 1:10:17 Yeah, yeah, it does. But I'm gonna ask another vague question though. I'm sorry, no, you ready for the last one? Yeah. Where should people start if they feel overwhelmed by trying to lower their resistance? Is there a simple first step that someone can take to put them on a path to figuring this out? Do you start with food? You start with your weight. Because you hear people talk all the time, like I can't lose weight. Type ones are going to say to you, all the time, I can't lose weight, because every time I try to exercise, my blood sugar falls and I end up eating to bring it back up again, and it feels like I'm just losing weight on one hand and eating it on the other hand. And I would tell you, if weight is your issue, then getting your your settings right so that you can work out would be step one. It wouldn't just be, hurry up and start working out, correct, you know? But also, if you don't start working out, you won't see that your needs are lesser. So it's, it's a chicken or egg thing, a little bit like, do you start working out and adjust your insulin as you go? Do you adjust your insulin? Get it really rock solid, and then start working out and keep adjusting I think maybe that's it, right? Yes, yeah, yeah. And

Jennifer Smith, CDE 1:11:24 I think in terms of resistance, let's say you've you've taken all of the advice, right, especially like from the podcast, let's say all the pro tips, you've applied them, you've tested and you've done the best that you possibly can, and with all the adjustments, you've actually found, gosh, my insulin needs are a lot higher than I actually thought they were, and it is, no matter what lifestyle piece I put into place, it is really hard to keep my blood sugar at the target that I'm aiming for. Great. Now you've got all this information to go to your physician, to your nurse practitioner, to your educator with and say, Look, I've done all this work, and I still feel like I'm using a lot of insulin to actually navigate despite all the things I'm trying to do. Yeah, great,

Scott Benner 1:12:13 Jenny, I get worried that the the actionable items all fight with each other. For example, we learned in this episode, that a sign of insulin resistance might be hunger. And then you're gonna go to your doctor, and they're gonna say, Well, if you lost some weight, your insulin resistance would get better. You should lose some weight. And you go, but I'm hungry all the time. And then they say, Don't be. And you go, but I can't not be because I got insulin like, you don't mean like, you get caught where? Like, hey, go work out. You're like, I work out. My blood sugar gets low. Everything seems to have it's like a bad cartoon, like superhero movie, like there's a bad guy for every moment that you have. And I can see how it would stop people from it gets frustrating. Yeah, right. I mean, listen, between I don't have type one diabetes, I don't have type two diabetes. I've never been I don't think I've ever been pre diabetic, but I have lost like 60 pounds on a GLP medication, and the hunger going away was a huge help. It just was like, you know, like it was such a big deal that helped me get over the hump. I will tell you,

Jennifer Smith, CDE 1:13:16 that's the biggest thing that I hear from most people who start using it, is the food fog. People call it the constant draw of I even have some people who have said, you know, I work from home. I leave my office and I have to walk through the kitchen. And since using the GLP one, I can walk through in the refrigerator or the cabinet the cupboard, I can pass it without even a thought of opening it at this point. You

Scott Benner 1:13:44 have no idea how well it works to the point where you have to remind yourself to eat. I had to remind myself to eat. Like I would get up and be like one two in the afternoon, but God, I feel lightheaded. And then I'd go over and I go, Oh, I didn't eat. I did no hunger whatsoever, like none I forgot to eat today. Easily. I could have gone 24 hours not eaten, and never would my brain have said you're hungry, or my stomach have grumbled. That's the crazy part, but it's also a huge boost. Now, I'm not saying run out and use a medication. I'm saying listen to this. Hear the ideas about what'll make it better, but then identify what's stopping you, because you may have to conquer that before doing the other thing that's all right. They're

Jennifer Smith, CDE 1:14:23 all really like valuable things to keep in mind. Because, as you said, people may go to the doctor and say, but I can't he says, stop eating, or don't eat many snacks. Or I can see how much you're in taking cut it back. And for those who really struggle with some mental stuff around food to begin with, that can be a road to nowhere to just tell them something that the doctor doesn't know. What they feel like, yeah, and it stinks.

Scott Benner 1:14:51 Well, the and the other side of it is too. And I have personal experience with this, with what happened to my wife is she went to an endocrinologist and said, like, Look, I'm just gaining weight. Eat for like, no reason, and lose weight, lose weight, lose weight. And they tested her thyroid, and her TSH was high, but in range, so they didn't give her medication. So for seven years, they yelled at her to lose weight as she gained weight. And then one day, it just took one of us to, like, you know, I guess you people call it advocating for yourself, but I basically just, like, said to the guy, like, just give her the medicine for God's sakes. Like, if it doesn't work, like, take her off of it. But like, what's the harm at this point, right? She starts taking Synthroid, and, boom, oh, what do you know? Look at that. Yeah. And so, like, even when you figure the problem out, sometimes there's another roadblock. And I see that with people all the time. They go through this horrible thing to figure out their problem. And they get to the person, they're like, hey, gatekeeper, give me the thing. And they go, No, you can't have the thing. And it's tough. You know, finding a doctor who understands what you figured out is a big deal, and I it's a whole other process to talk about how to explain that to a doctor. But, you know, I just don't give up. Is my is my message? I guess, yeah, yeah, no. All right, Jenny, this was awesome. Thank you very much. Of course, yes. Thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juice box. This episode of the juice box podcast was sponsored by us med. Us, med.com/juice box, or call 888-721-1514, get started today with us. Med, links in the show notes. Links at Juicebox Podcast com, 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 CD CES, a registered dietitian 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. The 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. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. 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, wrongway recording.com, you.

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