#1763 Defining DIabetes: Sliding Scale
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Scott and Jenny define "Sliding Scale" in this Defining Diabetes episode.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:00) Friends, we're all back together for the next episode of the Juice Box podcast. (0:03) Welcome. (0:14) Managing diabetes is difficult, but trying to do it when you don't understand the lingo, that's almost impossible. (0:21) The defining diabetes series began in 2019, and today we're adding to it. (0:25) Go to juiceboxpodcast.com up in the menu, click on defining diabetes, and you'll see a complete list of all the terms that we've defined so far.
Scott Benner (0:35) Check out my algorithm pumping series to help you make sense of automated insulin delivery systems like Omnipod five, Loop, Medtronic seven eighty g, Twist, Tandem Control IQ, and much more. (0:48) Each episode will dive into the setup, features, and real world usage tips that can transform your daily type one diabetes management. (0:55) We cut through the jargon, share personal experiences, and show you how these algorithms can simplify and streamline your care. (1:01) If you're curious about automated insulin pumping, go find the algorithm pumping series in the Juice Box podcast. (1:07) Easiest way, juiceboxpodcast.com, and go up into the menu.
Scott Benner (1:11) Click on series, and it'll be right there. (1:14) While you're listening, please remember that nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (1:22) Always consult a physician before making any changes to your health care plan or becoming bold with insulin. (1:29) Jenny, we're gonna define sliding scale, and I'm probably gonna ask you to go back into your way back machine back till you were how old? (1:37) When do you think is the last time you did that?
Jenny Smith (1:39) Oh my god. (1:43) Sliding scale use was trying to think. (1:48) I was in college when I stopped using sliding scale because rapid acting insulin Humalog
Scott Benner (1:57) Mhmm.
Jenny Smith (1:57) Came out. (1:59) So it would probably have to be trying to think I was working. (2:04) Funny of the memories that come in. (2:05) I was working at a plasma donation center when I read an article on my break about Humalog. (2:11) Really?
Jenny Smith (2:11) It's really interesting. (2:12) Yes. (2:13) And then I had a doctor's visit coming up very soon, and I went to him with the article. (2:18) You know, like, Internet and stuff was very Yeah. (2:21) Microscopic at that time.
Jenny Smith (2:22) So I brought him the article so I wasn't, like, the crazy person. (2:25) Mhmm. (2:25) You know? (2:26) And I was like, this
Scott Benner (2:27) Yeah.
Jenny Smith (2:27) This is what Jenny needs right now because RNL is not working very well for Jenny.
Scott Benner (2:33) So And please ignore that I stole this magazine from the plasma center. (2:37) Right.
Jenny Smith (2:38) You know, it's all okay. (2:41) Sliding scale probably until I was a sophomore in sophomore junior in college, I think
Scott Benner (2:51) Okay.
Jenny Smith (2:51) Is where I was using that. (2:53) And it's really it's the best that you could have had outside of using a pump eventually that was programmable in a way that could manage better. (3:04) Really, it's just you get a set amount of insulin for a meal. (3:08) Mhmm. (3:09) Breakfast is three units.
Jenny Smith (3:10) Lunch is five units. (3:11) Dinner is six units. (3:13) That's your dose for the food, and it's given to you with the expectation that your education included, your meal will consist of this much food. (3:22) Don't veer from this because your insulin is dosed according to what we told you you needed to eat. (3:28) Right.
Jenny Smith (3:29) And then if your blood sugar sliding scale corrective was also another math part to add to that. (3:36) If your blood sugar is here to here, add one unit. (3:39) If blood sugar is here to here, add two units or three units. (3:43) And so it was really it was management that was very wide.
Scott Benner (3:47) Yeah.
Jenny Smith (3:48) It was not the precise that we can have today.
Scott Benner (3:51) Do you remember back I know you're you're a particular eater. (3:55) I don't mean that, like, in a in a finicky way. (3:57) Just mean you're you do a good job with your with your intake. (4:00) So I imagine your sliding scale for your food worked pretty well. (4:03) Am I right?
Jenny Smith (4:03) It did. (4:04) Yeah. (4:04) And because my parents, especially my mom, was kind of the controller of the food until I went to college
Scott Benner (4:10) Yeah.
Jenny Smith (4:11) Everything was weighed and measured. (4:13) And, like, we had a bouncy scale that sat in the kitchen table Mhmm. (4:17) And it everything got measured. (4:18) Everything got weighed. (4:19) And it was thankful that I had really good educators too that made it it made it workable in my brain at that age too.
Jenny Smith (4:27) Like, this is just the way that it works. (4:29) And look. (4:30) With all the activity, I mean, I danced. (4:32) I was in volleyball. (4:34) I was a cheerleader.
Jenny Smith (4:35) I did a I biked with my dad. (4:37) I did a lot of things. (4:38) And so with those variables, I saw that if I just stuck with the schedule that I was given Mhmm. (4:45) It worked out pretty well. (4:46) Now what happened in between finger sticks?
Jenny Smith (4:48) I don't know. (4:49) Like, there was no CGM to say, gosh. (4:51) This dose really is the right one for you. (4:54) But
Scott Benner (4:55) Is it fair to say that most see, I don't think this is true because I talked to so many people who are on a sliding scale right now. (5:02) Like, it happens it happens to Canadians a lot depending on what province they live in. (5:07) And I am surprised more and more about Americans that I hear who are like, oh, no. (5:12) I'm on a sliding scale. (5:13) I'm like, how's that possible?
Scott Benner (5:14) It's like hearing somebody uses a fax machine. (5:16) You're like, what? (5:17) Right? (5:18) But but is that still pretty common?
Jenny Smith (5:20) It can be. (5:21) You know, we especially what I do with the clients that I am able to work with
Scott Benner (5:26) Yeah.
Jenny Smith (5:27) I see a lot of people who have access, really, I think is what this speaks to. (5:31) It's access to technology. (5:33) It's access to a clinical service that has encouraged you to to be able to be better because they're providing you the ability to have technology. (5:44) And many people don't have that. (5:47) So sliding scale is what it is.
Jenny Smith (5:49) It's you're told to have, you know, a dose of insulin. (5:53) And I what I've come to see too with some sliding scale people that I've worked with is they're not even given as much detail as I was given when I was using sliding scale. (6:04) Right? (6:04) It's eat breakfast, take three units of insulin. (6:08) There's not as much detailed your meal has to consist of this much food because we're expecting three units to cover your food.
Jenny Smith (6:17) Okay. (6:18) But if Right?
Scott Benner (6:19) If if you met somebody today who had access to insurance and they could get what they needed and they were on a sliding scale, would you tell them, I think you shouldn't be doing that? (6:29) Or would you say I I mean, is it different now that there are CGMs? (6:33) Like, are there people out there on sliding scale who are in a CGM? (6:36) Probably. (6:37) Right?
Jenny Smith (6:37) I would say that it defines sliding scale in a little bit of a different way Okay. (6:42) So those people are MDI still. (6:44) Right? (6:45) They may have a CGM, which gives them more access to information about what their doses that are set doses provide in control.
Scott Benner (6:57) Right.
Jenny Smith (6:58) I would even say that there are some people that might be using their pump as sliding scale instead of carb counting. (7:05) They may actually just be dialing in a manual dose of insulin, and then potentially, they might have a correction factor put into their pump so the pump then automatically gives correction. (7:18) That could be another way of navigating sliding scale with a little more precision.
Scott Benner (7:23) Mhmm.
Jenny Smith (7:23) But in general, sliding scale is usually multiple daily injections with a set amount of insulin and then a corrective factor that's a set dose based on blood sugar value.
Scott Benner (7:34) You think there's a lot of yo yoing that goes on for people who are managing like this?
Jenny Smith (7:38) Very likely, unless they're willing to get you know, I have a couple of friends who use MDI and do very well with it. (7:44) Mhmm. (7:45) But theirs is a precision they've learned how to look at their CGMs. (7:51) They've learned how their insulin works for them.
Scott Benner (7:54) Mhmm.
Jenny Smith (7:54) They've learned the timing of their dosing. (7:57) Even though they are using kind of a sliding scale, most of them have also found that their most common foods, they've just figured out the dose for it. (8:07) They don't necessarily have an insulin to carb ratio. (8:09) They've just been able to say, well, gosh, you know, my bowl of cottage cheese with pineapple always takes four units.
Scott Benner (8:16) Mhmm.
Jenny Smith (8:16) I'll take four units and my blood sugar's high. (8:18) I add a little bit more to this. (8:20) Right?
Scott Benner (8:21) Okay. (8:22) I've never had cottage cheese in my life.
Jenny Smith (8:23) You've never had cottage cheese?
Scott Benner (8:25) And as you're talking about it, it makes me feel I just wanna say that.
Jenny Smith (8:27) Well, that's okay. (8:28) It's not I yeah. (8:29) It's all good. (8:30) I don't know why it even came to mind. (8:32) I was just trying to think of, like
Scott Benner (8:33) It was nice. (8:34) I just was like, oh, I've never had that.
Jenny Smith (8:36) There you go. (8:36) I did make you eat a tomato, though.
Scott Benner (8:38) I did. (8:39) I did have a tomato. (8:40) Where was
Jenny Smith (8:40) I? (8:40) Tomato.
Scott Benner (8:41) I was a that was we were on vacation, and the tomato came out. (8:44) Was like, alright. (8:44) I'll eat it. (8:44) And I did, and I sent Jenny a picture of it. (8:46) I said, look.
Jenny Smith (8:46) I ate the tomato.
Scott Benner (8:48) I don't know if that episode's out yet or if people have context for that yet or not. (8:52) So sliding scale is like like, put it, like, real black and white for me. (8:56) Take all the the the nuts and bolts out of it. (8:59) Like, I'm at the doctor, they're just gonna say, hey. (9:01) Put in this much insulin at this time.
Scott Benner (9:04) Eat at this time. (9:05) Eat this much food. (9:06) If your blood sugar is one fifty to one ninety nine, I want you to do this much. (9:09) If it's 200 to two fifty, I want you to do a little this much. (9:12) That's it.
Scott Benner (9:13) That's a sliding scale.
Jenny Smith (9:14) There's basal insulin behind it. (9:15) So usually the basal insulin is also once a day Yeah. (9:19) At this point. (9:20) Right? (9:20) And then mealtimes are covered with a sliding scale, which tends to work a little bit better at this point because many people, not everybody, but most people are using rapid.
Jenny Smith (9:31) They're not using the older r insulin, which took longer
Scott Benner (9:34) I was gonna say, are there I don't wanna muddy the two, so let's just say we're done talking about that now. (9:39) But, like, are there places in the world where people are still using, like, regular and NPH?
Jenny Smith (9:43) Oh, absolutely.
Scott Benner (9:44) Really? (9:44) Yeah.
Jenny Smith (9:45) Absolutely. (9:46) Yes.
Scott Benner (9:47) Well and then they're on a, like, an old school sliding scale at
Jenny Smith (9:50) that point. (9:50) And then they're on very old school sliding scale, kind of similar to mine. (9:54) It was just very structured. (9:56) There was not there was not deviation from time frames or where snacks were gonna happen or anything unless there was exercise in the picture that you
Scott Benner (10:04) I remember Mike always he kinda paused for a minute when he was drawing up his insulin, and I did ask him one day, what are you thinking about? (10:10) He's like, I'm trying to figure out how active we're gonna be today. (10:13) Mhmm. (10:13) And that was kind of the end of it. (10:14) Like, it was in the morning, and he was just it was weird to watch him.
Scott Benner (10:17) He'd, like, pull on that, and he'd like, and, you know, meanwhile, it wasn't obviously, his outcome was terrible, so it wasn't working for him. (10:25) But that was, I think, the extent of his training. (10:28) I'm making air I'm making air quotes.
Jenny Smith (10:30) I mean, you know, the old school stuff again with even the the intermediate acting cloudy insulin, the n and r Mhmm. (10:37) Whatever. (10:38) Like, I had a very different snack in the afternoon depending on whether I was headed to a sport right after school or not. (10:48) So snack for sport was this type of intake so that I wouldn't drop because I was on the tail end of my intermediate acting insulin. (10:58) Mhmm.
Jenny Smith (10:59) And it would encourage me to have a low. (11:03) And I so
Scott Benner (11:04) And I did.
Jenny Smith (11:05) All those things that you kinda figure out.
Scott Benner (11:07) As you go. (11:08) Okay. (11:08) Thank you. (11:08) I appreciate it.
Jenny Smith (11:09) Sure.
Scott Benner (11:17) If this is your first time listening to the Juice Box podcast and you'd like to hear more, download Apple Podcasts or Spotify, really any audio app at all, look for the Juice Box podcast, and follow or subscribe. (11:30) We put out new content every day that you'll enjoy. (11:33) Wanna learn more about your diabetes management? (11:36) Go to juiceboxpodcast.com up in the menu and look for bold beginnings, the diabetes pro tip series, and much more. (11:43) This podcast is full of collections and series of information that will help you to live better with insulin.
Scott Benner (11:50) Hey. (11:51) Thanks for listening all the way to the end. (11:52) I really appreciate your loyalty and listenership. (11:55) Thank you so much for listening. (11:57) I'll be back very soon with another episode of the Juice Box podcast.
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