#1456 Small Sips: Blanket of Insulin
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A longer-acting insulin strategy helps manage high-fat and high-protein meals more effectively.
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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 Hello friends, welcome to the sips series. These foundational strategies were nominated by listeners. They told me, these are the ideas in the podcast that truly made a difference for them. So I distilled them down into short, actionable insights. There's not going to be any fluff or complex jargon, just practical, real world diabetes management that you can start applying today. And I know your time is valuable, so we're keeping these short. Another small sip will come out once a week for the foreseeable future. If you like what you hear, check out the Pro Tip series or the bold beginning series for more. Those series are available in the menu at Juicebox podcast.com and you can find complete lists of all of the series in the featured tab on the private Facebook group. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The questions you have, I guarantee you there's answers to them in the Juicebox Podcast, and it's all free. You I like blanket of insulin. You want to go blanket of insulin? Yeah,
Speaker 1 01:32 I like that one that. I think that's a good one. Do
Jennifer Smith, CDE 01:36 you remember what I said? I don't remember what you said, honestly. But just looking at the title of it, I'm assuming that it has something to do with almost like an extended Bolus or a Temp Basal use, or expecting that the food that you're eating, which we kind of alluded to already in a lot of these that we've just done, is that it's not just carb that you're eating most often And that you might need a stretch out of insulin, and
Scott Benner 02:03 that ends up being the answer to the question. But my but the reason I once said I remember saying it to you, by the way, because I used the weird phrase and you laughed. So I Oh, I remember saying to you in a carby situation, and then you laughed at carby, oh, in an overly carby situation, I try to think of it like this. So first things first, your basal is set where your basal set right. And if you most days eat a certain way, and then all of the sudden, on Saturday, are like, I'm going out for pizza. I'm not even gonna get good pizza. I'm gonna go to Pizza Hut. No disrespect to those you who like Pizza Hut and like, so I'm gonna get, you know, frozen crust, you know, like, because, you know, the meat lovers probably cheese, you know, like, like, if I'm gonna go eat all of that, what happens is people say, Well, I expect my blood sugar to go up. What I say is, I expect your need to rise. So I used to tell people this is before automated systems. In situations like that. For my daughter, I would lay what I thought of as a heavy blanket of insulin over the timeline of the impact of the food. So generally speaking, I would use a Temp Basal increase,
Jennifer Smith, CDE 03:14 right, right, most effective for high fat and again, conventional pumps eons ago, before any of the aid systems and the compensations and all that kind of stuff. But yeah, it was either Temp Basal, usually was for really high fat, or the potential of even knowing that again, with experience your pizza example being, well, gosh, I Bolus the whole thing. I go low and then it sits high for hours and hours and hours later. So it might even be two smart feature uses, like an extended Bolus, as well as a Temp Basal for hours later.
Scott Benner 03:49 Yeah, my thought here is just that. I mean, it's obvious, like you're going to hear your doctor talk about, they call them square waves anymore. Does that? Is that saying, Go on? Is it just
Jennifer Smith, CDE 03:58 it's interesting, because the square wave and dual wave. I think they were coined by Medtronic, if I'm correct, like eons ago, because their pump offered the ability to choose between the two. One the dual wave being dual two, part 1% of insulin now of the total Bolus, the other percent delivered over a time period, and then the square wave was the whole amount delivered over a time frame that you designate. Oh, okay, so, yes, yeah,
Scott Benner 04:26 and so like, Omnipod dash still does extend it like some now the rest over a time frame. So, like, for those of you who don't use this feature, if you you know as an example, pizza is a good example, right? Like, it might not hit you right away, but you need something at the beginning, but it's going to hit you harder, like 45 minutes in. So you might do, you know, you might say, Okay, I think this is, I don't know, 50 carbs. And your pump might say, that's five units. You might say, Okay, well, then I'd like two units to go in now, and the other three units to go in over the next 40 minutes, or whatever. Right? Right, right. Extended Bolus. I would do that, and on top of that, do a Temp Basal increase, like sometimes. So like, what I ended up doing Jenny is I would look back over a failed experiment and say, you know, I used their carb ratio, and it said she needed five units. But by the time this fight was over, we ended up using more like seven and a half, yeah. So I'm like, let me get those other two and a half units in there. Somehow, I used to think put it in as basal, because you could always take the basal away, right? And it wouldn't be as impactful as just jamming in the two and a half units. Like, maybe I'll just do, I mean, just say your basal is, I don't know, you know, a unit an hour, I might just make it 100% increase for two hours to get in two extra units of basal. You could always bail on it later, and it shouldn't have as big of an impact as just throwing it in the whole two units at once and realizing you didn't need it. But I think that overall, I think the takeaway I would like people to have is that, you know, food or, you know, stress, anything that's trying to push your blood sugar up is being met in my mind, by a force above it trying to push it back down again. And there's an amount of basal I usually use, there's an amount of Bolus I usually use. And when we get into carbier situations, those settings I have might not work. I need more resistance on the top half, pushing down on that number, and I would try to find ways to spread it out that was most effective while still being something I could get away from without causing a low. So in my I know it's weird, but in my mind's eye, there's a blanket of insulin over the timeline of the impact of the carbs. That's how it seems to me.
Jennifer Smith, CDE 06:44 Yeah, it's a great way to think about it. I always, I always describe fat to people like the fat is sitting on your insulin, kind of like you'd sit on a bean bag chair, right? It's nice and puffed up in a circle. You sit on it, what do you get? Like, a 50% reduction in its normal, puffed up feature, right, right? So you sit on it. You are the fat. You are decreasing your basal now in its effectiveness from one unit an hour, 2.5 units an hour, because fat creates a resistant environment. Now, like you said, I love that example. Because you're using a Temp Basal you can easily cancel it. And now when you stand up from sitting on the bean bag, if you've got a good bean bag chair, it starts to puff back up pretty quickly, right? And so then you can take that away without effectively having a long lingering impact,
Scott Benner 07:41 yeah. I remember when Arden moved to an automated system. The first one she ever used was loop, and I had an app where I could watch it giving and taking away basal. And I remember having this moment where I was like, oh, it's doing what I've been doing, yeah. And I thought, maybe I could stop doing it now,
Jennifer Smith, CDE 08:01 maybe I can sleep finally, actually, that's,
Scott Benner 08:03 that's what happened, is I got to sleep because the things I'm talking about, they don't end because you go to sleep, or, you know, because it's Christmas Day or anything like that. And while I did get a ton of experience and knowledge from doing it, which I guess is helping now with the podcast, I was tired, yeah. And now I take what I know and I can apply it to the automated system if I need to. Though, Arden's older and, you know, not as involved with me as she has been, I can apply what I know there, and I do sometimes. I sent her a text the other day that says, Arden using trio. Now, I sent her a text that said, Set attempt basal, like, just for a half an hour, like, like, it's taking basal away right now, but we don't want that. And I know we don't want that because you were just home for a break eating good, wholesome foods, and now you're back at school eating whatever the hell you just ate. And those settings that we had working real nice for your one week break, they're not working anymore. And yes, trio will get a little more aggressive in the next couple of days, but for today, it isn't and it needs help. So it's cut your basal away, but you need the basal, so put it back. And then I usually get a text back that says something like, stop. And
Jennifer Smith, CDE 09:17 at least even though she's responding that way, she's probably applying what you're telling her to do despite being like, why are Why are you telling me these things, like, I'm done? Please stop.
Scott Benner 09:27 Right? She does. She does. We're at that. We're at this interesting moment now where she doesn't want to tell me she's done it. It just happens without her saying it. But stop. Is our diabetes love language? Yeah, so, hey, is this a real low stop? I'm like, well, at least she knows she's low. Yes,
Jennifer Smith, CDE 09:43 trioza. I mean trio and the other algorithms are really they add another level of this blanket of insulin that requires attention when you first start using them, because conventional pumping to aid. Jumping is a jump. Yeah, you have to re learn, not necessarily, how insulin works, but how the system is working with insulin as it works
Scott Benner 10:11 for you. Right? In one of these episodes, I'll do the tug of war thing, which I think makes, makes the point about how I think about the blank of insulin slightly differently, but in a way that might help somebody anyway. I appreciate this very much. Thank you. Of course, if you're looking for community around type one diabetes, check out the Juicebox Podcast, private, Facebook group, juice box podcast, type one diabetes. But everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. Are you starting to see patterns but you can't quite make sense of them? You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would, I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 if you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. You.
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