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Scott Benner 0:00
Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before becoming bold with insulin, or making any changes to your medical plan. I wanted to find Pre-Bolus Jenny, because I believe that if you just Pre-Bolus, you can knock about a point off your a one say it's not the first step when I talk to people, the first step is always we need to get your basal insulin right. But Pre-Bolus is incredibly important. Mm hmm. People don't do it for what I think of is probably two basic reasons. One is no one ever explained to them what it was, which is fascinating. And the second one is, they'll say, I don't need on a schedule. I'm a free loving person. I'm all cool and hip, and everything about my life is free and easy. And it's hard for me to tie myself down man, like, like, right here, then they'll complain about their budget or being high for five hours in the fight they were and I was like, we just need five seconds worth of focus about 15 minutes before you eat. So let's define Pre-Bolus first.

Jennifer Smith, CDE 1:11
So Pre-Bolus thing essentially, is when you take insulin at a set time before keyword there before actually starting to take your first bite of food allows time for our poorly named rapid acting insulin to get more active in the system. Because food specifically carbs have very quick impact. The saliva in your mouth starts to break things down so that when it gets to your gut, it's gonna be easier even to break down. So taking insulin, before you start to eat, goal being about 15 minutes, give or take. But a 15 minute rule of thumb to start with if you've never been doing it, and you're hearing this and like, oh, let's give that a try. 15 minutes is a good rule of thumb to sell,

Scott Benner 2:05
and then you can find out. I tell people all the time, you can use your CGM to figure out your Pre-Bolus time, people will be like it's longer, it's shorter, whatever, I don't know what you're gonna be. But you can get your blood sugar stable at a lower number, right like 30, nice and stable 130 for a couple hours, get all the insulin out of you then hit yourself with a bolus that you think's going to take you to 90 and see how long it takes for that to start moving. Right? Once your blood sugar starts moving, that distance of time is about about what your Pre-Bolus is. I just saw something. So I googled it right while you were speaking. Uh huh. I was gonna do that thing where I'm like, Jenny, now I'm gonna read the definition from the internet. And the seriously satis thing happened and I'm not joking. The second return for the words Pre-Bolus definition are from Arden's day in the Juicebox Podcast, I can't believe how is that possible? Awesome. No, it's not awesome. It should be like coming from like nine hospitals and like, like,

Jennifer Smith, CDE 3:01
well, I'm saying that it's awesome that it's there at all.

Scott Benner 3:05
But yeah, but the point is, is that what does Google Search just told me was is that nobody tells people about this. It's literally not.

Jennifer Smith, CDE 3:14
Are there any hospitals? Are there any hospitals that are even listed on your Google search? Are there any, like therapeutic

Scott Benner 3:22
to blockhouse? Mine. And then the next one that pops up is a definition for the word Bolus. And it says missing pre. So it's not even. Yeah, there's three things that say Pre-Bolus on it. And one of them is somebody saying I can't seem to do very well with my meal boluses. And it's somebody just complaining about Pre-Bolus. The word definition is excluded from the search. So I am the only search that has the word Pre-Bolus. And it's because on my blog posts, I have some of them tagged because they're about Pre-Bolus. Sure, but I just it's just really sad. Like, I listen, I did not set this up. I wish I did not be a genius. But I really got sad, like when I saw it, I mean, there's a Wikipedia entry. That's even not helpful. It says, a Pre-Bolus of insulin can combine a meal bolus and a correction bolus. When the blood sugar is above the target range before a meal. That's not accurately what a pre marlis is.

Jennifer Smith, CDE 4:21
And that's not at all the time.

Scott Benner 4:23
The timing of the bolus is a controllable variable to bring down the blood sugar level before eating again, causes it to increase.

Jennifer Smith, CDE 4:33
That's entirely wrong. That's right.

Scott Benner 4:36
Yeah, sad. Okay.

Jennifer Smith, CDE 4:38
I never look at Wikipedia for any Oh,

Scott Benner 4:40
yeah, that's not I'm just saying that's the only other thing that popped up like that. Yeah. That's so sad. Right? Okay, so we'll change that. I'm gonna get what Jenny? I'm going to take this audio and I'm going to build a web page. It's just about Pre-Bolus. And I'm gonna make sure I'm gonna get people write blog articles about it, and I'm gonna turn it to a thing because Listen, here's my definition of Pre-Bolus. And I'm sure Jenny just said the same thing. I'm about to say Pre-Bolus sing or pre injecting or pre, whatever you want to call it. It's not really pre nine, if you really think about it, insulin does not go into your system and start working right away. Right? Say it all the time. It's not a light switch, you don't just flip a switch and it happens. Insulin right. So while to work. Mm hmm. You need the impact that that insulin is having on your blood sugar to coincide with the, the food or your you know, anything else, it's trying to make your blood sugar rise, you want to get involved in a fair fight. And I guess this is this place of time is to say it is all you know, it says, Oh my gosh, I just, I don't even know what I was just trying to say that this is a good place to say this. It's a tug of war that you don't want either side to win. And if you just yell, go and let both sides start pulling both sides being insulin on one side and carbs or body function on the other. If you just yell go, carbs and body function are always going to win because it takes a while for your insulin to come online. You need insulin in your body sooner, so that it comes online when the carbs start pulling so that instead of the broke getting jerked all the way on one side. And now that you know your carbs are winning this tug of war greatly, then all the sudden your insulin comes online starts pulling the by then it's too weak. Because you know you only bolus for the carbs you counted, you did not bolus for the momentum that the carbs now have or the distance between your target blood sugar and where it is now. You were 90 when you put the insulin in. Now you're 150 your blood sugar shooting up you have this momentum you have to stop you have to bring the number back and you have to cover the food but you only put in insulin for the food. But if you put that insulin in for the food in time for it to begin working when the the carbs try to pull on that rope, then the carbs can't move the rope because the insolence add its power then and it's fighting. So when you see somebody with a straight line on their CGM online, that's what's going on behind the scenes, the insulin and the carbs are embroiled in a battle that neither of them can win. Right? And then they hired they dropped the rope in the center of the rope is right where it started. And that's how my weird brain thinks about bolusing.

Jennifer Smith, CDE 7:16
So it's a very, it's a very good example of the tug of war I've used several times since you mentioned it because it's a very easy way to consider what your goal is in using Pre-Bolus it's very easy to comprehend even for kids. It's very easy to comprehend a game of tug of war 100%

Scott Benner 7:41
Sure, yes, for sports fans soccer fan. It's not Pre-Bolus things like playing without a goalie. Are you a baseball fan? It's like hitting off a little leaguer? Are you a football fan? It's like not having an offensive line expecting your quarterback not to get sack basketball, imagine they raised the hoop to 50 feet, right? Like these are the situations you're putting yourself in if you're not Pre-Bolus. And I'm telling you right now, this podcast is incredibly helpful. I mean that and I think you'll find it to be helpful. But if you just Pre-Bolus you're going to get an A one c reduction. That's it. I mean, the rest of it is hugely important. But this is this is this is 1 billion steps. It's understanding your basal insulin, which technically is Pre-Bolus saying right having the right bazel is nothing more or less than having your basal insulin be at the right power at the right time. Being you know, Pre-Bolus thing is having a meal insulin at the right power at the right time. Okay, I can't give away all the secrets or there won't be a podcast.

Jennifer Smith, CDE 8:40
Not true. There's always something to discuss with

Scott Benner 8:42
diabetes. Definitely not true. Jenny Smith is not just the delightful voice you hear on the Juicebox Podcast. She's also a real live person with a job and she works at integrated diabetes. If you'd like Jenny to help you in your personal journey with Type One Diabetes, go to integrated diabetes comm find Jenny's profile and send her an email. There's also links right here in the show notes about you know how you can do that. I think there's actually even a link there to her email. And there's a brief description of her you know, Bona Fie days Why it is you might want to give Jenny a ring. Thanks so much to the sponsors Dexcom on the pod and dancing for diabetes. There are links in your show notes at Juicebox podcast.com. Where you can find out more about the dexcom g six continuous glucose monitor. Figure out what's going on at dancing for diabetes.com and order a free no obligation pod experience get that's right a free no obligation demo of the Omni pod