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Scott Benner 0:02
This episode of defining diabetes on the Juicebox Podcast is sponsored by companion medical makers of the impact. You can find out more about the in pen, ai companion medical.com. On today's show, Jenny Smith and I are going to define a term from your diabetes life. This one's very specific to the podcast, stop the arrows. What does that mean? This is going to be one of those where I'm like, Jenny, hey, I made this up. What do you think of me is

injured. Jenny's gonna tell you. That's how this works. I say Jenny define this. And he goes, Oh, that means this. And then I say something. I'm like, haha, I think this bah, bah, bah. And then she goes, Oh, I agree with you. The baby, sometimes she'll be like, I don't agree with you. And then she'll be more clarifying. And then it's over. Defining diabetes. There it is. That's the magic. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan for becoming bold with insulin. Alright, you're ready for Jenny? She's particularly delightful in this episode.

Why don't we define a couple of more like podcast tenants. And so this is where this is where I asked Jenny to define something that I've made up. And that way she can. Either always fun, right, right. Yeah. Right. Cuz, you know, I had, you know, we did the we did defining, you know, over Bolus, which again, is just a word I made up. And and we'll do some other ones. So we've done a couple. And some of them are bigger ideas are not just words, right? So if I told you that I consider stop the arrows to be a real diabetes term. It is it is to me and I think enough people do it now that that I'm buying into my own my own hype, a little bit on that. If I said to you, can you define stop?

Jennifer Smith, CDE 2:19
You are because on our assessment, on our assessment, many people actually say, I found you from the juice box. And I want to be able to stop the arrows. And many of them actually have it like in quotes, as if they're like, it's Scott's term. So I have to like quote him on. Oh, yes.

Scott Benner 2:38
Let me just say I appreciate the attribution. I really do. I get ripped off a lot in this space, Jenny. But when people say they heard it from me, it makes me feel better. So that I like that. So stop the arrows. What does that mean, to you?

Jennifer Smith, CDE 2:53
To me, essentially, you are both up arrows and down arrows, and very significantly straight up arrows and whatnot, it's essentially just pay, it's reacting to the arrow and saying, I need to stop this and plateau it I want to get it to even out. And that might be with some type of insulin adjustment, it might be with a little bit of insulin adjustment and some food of some type. But that stopped the arrows pay attention to, I think stopping the arrows also has to do with alerts and alarms, too. So I think that needs to be brought into the picture. Because unless you're physically like looking at your screen all day long, you may not see some of the arrows to stop.

Scott Benner 3:36
I don't want people to stare at their glucose monitor, right? I very much am against that idea. Like you. That's why I like your alerts being set in tighter tolerances, so you can find out earlier and do something sooner. So yeah, so when I first thought it, like when I was and trust me, I didn't sit down in a you know, think tank session and to say, I wonder how I could describe to people I was just, in a moment, my life. And I saw these arrows. And I thought to myself, I gotta stop these arrows. And you know, and I just I have to like Why look at this happening here. So in my mind, I see it as you know, you guys have heard me describe it before I just see it is putting more resistance on the side of direction that the arrow is trying to go, the arrow is trying to go up, I try to put more insulin over top of it to push the arrow back down again, if I if I have an arrow going down, I think of it is putting food underneath it to push it back up the other day. I described it to somebody. So I am going to say something. I need to give myself credit for something. I wish I speak in pictures. I really do. And I know that about myself. And sometimes I'd like you know, I'll do the tug of war thing. And then somebody won't get the tug of war thing and I'll be like, Oh my god, they didn't get that. Alright, I'll say it like this. So I was trying to describe stop the IRS as somebody though today. And I thought they're not getting it and then I said hey, you're a football fan, right? Okay, I said okay, so imagine your offense goes out on the field. The regular offensive line center two guards two tackles and a quarterback behind the center and you get sacked. On the next play, you might bring in a tight end and ask the tight end to help block. Now if you still get sacked, you could bring in a running back and tell the running back Hey, after we say hike, stand up, chipper blocker real quick, knock him off his path a little and then go out and try to catch a pass. If that doesn't work, you might bring in another tight end right. So in some scenarios with insulin, five linemen do the job five linemen can keep back a low blood sugar right keep you from getting sacked or keep back a high blood sugar keep you from getting sacked. But sometimes you need tight ends the block too sometimes you'll also need a running back. So sometimes you have to bolster your side so the other side can't get to you. And that's insulin like like it's just how I like that's just how my silly brain sees it like like so if you're trying to get low, like your blood sugar's trying to go low. That's the defense sacking you you need more blockers and then that Caserio, those blockers are carbs, right in the exact reverse situation. If you're trying to get high, then the insulin is trying to sack you. And you need to keep the insulin away from your quarterback like break, you know, or, you know, I'm sorry, if you're trying to go high down, the carbs are driving you up, you need more you need more insulin. So you bring in instead of blockers you bring in like attackers like people to like push back in the end, you're just trying to keep this this never ending back and forth like this, just like a pirate ship just rocking back and forth. You just asking like you're putting 100 people on the deck of a boat and telling them run to the right, run to the left, or the right run to the left like and again.

Jennifer Smith, CDE 6:46
That is how really you just want them eventually to like run to the middle at all

Scott Benner 6:50
stabilizes our do this, do that. And then eventually, exactly, every hundred people be in the middle and they'll be like, oh, what's our job now we got the boat stabilized

Jennifer Smith, CDE 6:57
standstill.

Scott Benner 7:00
I am totally gonna blow my own horn and tell you I've never had that thought before until I just had it right now because my stupid brain works in pictures. Okay, so that's what you're trying to do. I've in the past described it as scales of justice, but have holes in either side, and you're constantly putting an insulin in one side and carbs in the other and just trying to keep them from flopping down on one side. So any way you can think of stopping the arrows. I don't care, like whatever picture you have to paint in your head. But the truth is, is that if it starts getting away from you, you can't stand there and watch it. Right because then your quarterbacks gonna be out for four weeks with a broken collarbone, you need to do something right. So when so when I see, for me, it's diagonal up at 120. So and that's partly to do with Arden's physiology to a 118 diagonal up that goes to a 120 is about to go to a 125 straight up and Arden I know how that works. I can look at that line on that Dexcom graph and see it coming. So right he hits the 118 I can Bolus Mm hmm. And that stops the arrow. Right. And so now I create a plateau and then I watch it. And if the plateau doesn't come back, then I re address and I get it back again. But in my mind, I just messed up the Bolus for the meal somehow, had I put in whatever amount stops that arrow if it was in up front, the arrow wouldn't move up. Right there were also times Today's a great example, where Arjun texts me and says, Hey, I'm going to get breakfast. And I was like, Okay, so the last three times she said that at school. It's been a muffin. So I put in the muffin bolus that I had figured out. And then like 10 minutes later, she was Oh, hey, by the way, they didn't have any muffins. I got a bagel. It's just like now I live on the east coast. A bagels are a real thing here. It's like a real thing for bagel got still here and I threw it at you. I could kill you with it. You know? Like it's a big dopey thing, right? And it's not all like dry like you and like Indianapolis are thinking right now or you know, like often, like you guys out in California are thinking about I'm sorry, this is like a lump of like dough. Okay? So I'm like throwing in more insulin. I'm like, Arden, this is not gonna work, right. But let's just see what happens. And it worked for a long time, actually, for like an hour and a half. We were ahead of it. And I saw the curve up. And as soon as I saw it, I was like, Oh, god, oh, god, it's coming. And I just didn't hit it hard enough. So now Arden's like 195, and she's stable at 195. And we are putting more insulin on to get it back down. But now I'm also thinking about two things. I'm thinking about this, you know, this stability, stable arrow trying to turn it into a down arrow, and she's gonna eat lunch in 45 minutes

Jennifer Smith, CDE 9:53
and lunches. I was just gonna say lunch is coming for you.

Scott Benner 9:56
What do we do with that? Tell you what we're gonna do with it. We're going to start An arrow, then we're gonna stop an arrow. Okay, so we're going to make a really large bolus in about 30 minutes about 25 minutes before she's going to eat. I'm going to bolus her whole lunch. And, and I am going to try to use her lunch bolus to drop this to start an arrow, right. And then I'm going to use the food at lunch to stop the stabilizer, yes. And then I will reassess about an hour after she's eaten. But there's all different kinds of ways to stop ours. And moreover, to stop the direction and the momentum of your blood sugar. You can you know, I've said it a million times. But you can't just think about how your insulin impacts your blood sugar, you have to think about how your blood sugar impacts the food you're eating, how the food impacts your blood sugar, how the food impacts the insulin like these things all have this sort of like weird symbiotic relationship together. And we get it drilled into our head that diabetes is about a number and making a number go down with insulin. So much, so much more than that, if you know how to manipulate those arrows, meaning the direction of your blood sugar.

Jennifer Smith, CDE 11:15
Well, and you've also, you've also paid enough attention, as you said, if you get that angle the arrow up and it's 118 you know what's coming. And you know what's coming, because you've had experience with paying attention before. So sometimes, sometimes I actually talked to people about even watching to begin with when they're trying to be more bold with insulin, when they're trying to be more aggressive. I say, you know what, if you're worried to begin with, pay attention first, see what happens? See, let it let it go up. See how much once it goes up? How much does it take to bring it back down? Because if this is a consistent, that you're always needing one extra unit after lunch every single day. And even if your lunches a little bit different day to day, you're always adding an extra one, one and a half units. Okay? Well, one, something probably is wrong with your ratio, because we need to adjust it which also then just means you need more insulin up front, right? So we can learn from also watching. And you don't have to watch for a week with aiming for high blood sugar's just to be able to watch, you can do it a couple of times and say, okay, I've learned something here. Now I can be more aggressive, and I feel safe about it. So for people who want a little bit of assessment, that's kind of also a way to do it.

Scott Benner 12:32
That's brilliant and 100% necessary and what Jenny just said, you right, what you just said was 100% needed absolutely brilliant. poignant in the moment, do you want to know what happened in my head when you said that? What I thought Jenny just said, you have to take a strike. Do Yeah, you have to take a strike. So you can see how the pitchers throwing, right because you're going to swing it the first one and Miss anyway. And then you've lost the experience of watching the pitch cross the plate. So sometimes

Jennifer Smith, CDE 13:02
I told in my in my one of our to doing half marathon to get to finally doing like a half Iron Man and a whole full marathon and everything. I took a lot of strikes, trying to figure out what I needed to do to manage. And the strikes. They suck from a like perspective of that mental internal management that you always are aiming for. It's gonna work this time and I'm going to try this and there's going to be perfection, there's no perfection. There's, you get to a point of figuring some things out, like, you know, my long distance running strategies, I've figured it out. And unless something is completely just weirdly off 99% of the time, my strategy now works consistently. But I did I that's a great way I took a lot of strikes, figuring it out. How much nutrition do I need? How much bolus Do I need to shave off? Do I need to change a basal rate during or after? Or how far ahead of time or whatever. And so some of it is it strategizing and I kind of feel like a 30 year guinea pig.

Scott Benner 14:14
I'm gonna figure this out. But you know, it's interesting, it occurs to me like you said, that is it You and I have Jenny and I are interesting. Like we I don't think we have a probably a ton of similarities. But we talk about diabetes exactly the same way and we have the same sort of resolve about it. And it's obviously much easier for me to have the resolve than it is for you because you're living it. I just look at a person and go Yeah, don't eat that yet. Okay, now, she's like, I'm hungry. And I was like, I wish I cared. Just don't eat it. Like it's like, you know, and that and even that like right is crazy. I just I grew up in the part of the country where my I've talked about before, like my dad would have cared if I was hungry if a doctor told right, like you can't eat that for half an hour my dad would have been like, again, I didn't know for half an hour, right? You're walking If you're sad, go tell somebody who cares, you know? And so so I've just enough 1970s parenting and made to do that. But but it is interesting when you and I agree we agree so incredibly like Jenny and I don't have like a like we're not like out seeing movies together. She lives in Wisconsin and I live in New Jersey. Although we are going to get to meet each other in person coming up. I think I think I've hopefully I think I've negotiated Atlanta,

maybe. Oh, lanta. We're gonna we're gonna probably bump into Atlanta. I think it's possible in Arizona. And there's no way I'm coming to Wisconsin and not making them bring you so. So anyway. But I love how much we agree about this. Like when people ask me, like, why, why Jenny? Like, why did you choose to do it with her? I said, Well, I had done hundreds of these podcast episodes. And I would always go back to the two times I had Jenny on every time she spoke, I just thought, wow, I agree with this person. Like, like, oh, and I have my narcissism allows me to believe that I'm right. So if I'm right, you agree with me? You're amazing, right? So I don't know if you're actually amazing. But my narcissism thinks you're terrific.

Jennifer Smith, CDE 16:11
I think you're great to

Scott Benner 16:12
see. And Jenny has that nice accent so you don't hear her being narcissistic. You just hear it from me with my Philly thing going on. I got a beautiful text from somebody the other day that just said, I love when Jenny says carp. Really? Cuz your accent that you don't hear. So

Jennifer Smith, CDE 16:31
I you know, I get most of it. I get for the old when I say something with an O in it like Minnesota, or whatever. You know, I in fact, a lot of people just ask are you are you from? You know, Minneapolis. Are you from Minnesota? I'm like, No, I'm from Madison. I live in Wisconsin. I am from the Midwest. I know it's my accent.

Scott Benner 16:53
They were just like, it's just a taxi said I love when Jenny says carb. I actually got a message while we were talking about Vicki's episode that just says, almonds don't have nipples. I'm laughing because I get a lot of like, while we're recording, I still get my messages from people. And sometimes I'm like, Oh, that's from like another episode. That's so funny that they're listening to that while we're recording this one. Funny, but No, but seriously, I you know, that's it. I think if you and I got married and had 17 kids with diabetes, we would just like, walk in like, we'd be like The Brady Bunch of taking care of diabetes. I just I feel bad for the time

Jennifer Smith, CDE 17:29
without adopting your children. No.

Scott Benner 17:32
I was just thinking about like your poor husband. Because one day you guys are gonna have a disagreement about diabetes. And you're gonna say Scott would agree with me about this. And that guy's gonna be like, who is Scott? And why is it coming up here in our house? Because I hear a lot. Jenny, you have no idea how many notes I get from married women who are like, my husband is tired of me saying the guy on the podcast says we should do. Oh, like you don't find that to them. They won't like that.

Jennifer Smith, CDE 17:58
I'll tell you what I'm gonna do Jenny. Yeah, my husband totally. He totally knows your name and it and you know that we would that we do these. In fact, he usually tries to keep our son coenen who's two and a half and he hangs out with during the day while I'm working and doing these with you. He usually tries to keep them as quiet as he can so that there's not like this big like, ah,

Scott Benner 18:17
like in the background. You name a kid. Come on. He's gonna be loud. You know what I mean? That's a that. You might have done that. Yeah, that's what I'm saying.

Jennifer Smith, CDE 18:26
He is a loud Irish little boy. He is Yeah. He is all about I want it. I can do it. No, Mommy, I've got this. He. He's got it all down at two and a half.

Scott Benner 18:39
Hey, you know what I'm gonna do one day. I'm gonna put a survey online to see how many people with autoimmune diseases have Irish heritage. Because I'm telling you, the pale white people have trouble. Seriously, like, like, you know what I mean? Like, there's something about that part of the world that you know, celiac and like, like, that whole thing is very common through that bloodline. And my wife is, is is English and Irish.

Jennifer Smith, CDE 19:08
So she Yeah, and I, you know, Finland, I'm sure you're quite quite familiar with the studies in Finland being the highest rate of development of type one in the world as far as a country. And from the studies that have been done there. They've really kind of narrowed it to the field of one some genetic predisposition. But from that it has to do a lot with vitamin D. One, they're at a very bad, like, latitude for actually absorbing and being able to have their body produce vitamin D the right way from sunlight. But two, they've also found that there's something within the body, the bodies there that actually it just doesn't develop and so they end up having very low vitamin D levels. In fact, I I can't remember the study when it was done. From when to when it was like 2006 or 2011, up to like 2015 or something where the they started supplementing at birth kids that were born in Finland, and once they started supplementing the rate of increase in development of type one stabilized, it didn't keep climbing. So it's kind of like a standard now is just supplement with vitamin D from birth. I don't remember what the dose or anything was. But yeah, there's, there are some very specific like, cultural populations that are very prone to type one diabetes and Orthodox Jewish are also have a very, very, very high prevalence of Type One Diabetes you ever heard the, the idea that the potato famine created depression in Irish people, the Irish,

Scott Benner 20:55
they there carries on to this day. It that's just like, there's the that's the stuff nobody thinks about, like you don't think about stuff like that in your day to day life? Well, that but there's, I don't know, there's obviously there's different groups of people who have been affected for I mean, listen to what you just said, but their distance to the sun? Or because they couldn't grow food for variable. Was it five years or something like that? They in 1800s? They did. They just ate potatoes that make it freakin sad, that's for sure. Yeah, you know, and then they say it actually changed their genetic code somehow to

Jennifer Smith, CDE 21:28
I wouldn't doubt I mean, the body, the body adapts, you know, I mean, that's why we have so many different animals that have like, you know, developed in the sea, and then they crawled out and they grew legs. And I mean, same thing in the human body. I mean, the real reason that we have some of the teeth that we have in our mouth, is because of where we started out. And now we may not really use those teeth the same way. And you know, it's,

Scott Benner 21:55
I just think it's, it's, it's important to remember when you're thinking about your diabetes, that there are there, we talked about the variables, but there are variables that you're never, you're never going to know. And so that's why I like boiling them down into simple ideas, like be bold, stop the arrows, use more, more insulin, because you if you, you see people sometimes online get frozen, trying to figure out what's happening. And when you get frozen like that you're the person in the horror movie that stops running. And oh, yeah, yeah, you don't want to stop and start screaming, he's got an axe, just right. Just remember, you just run Yes, you don't have to outrun the bear, just your friend. Okay, so

Jennifer Smith, CDE 22:37
don't go into the dark room where the funky noises are coming from escape away from the funny noises, you don't

Scott Benner 22:43
have to figure out all the diabetes variabilities just enough of them to get to the next moment. So like, just try to keep in mind you're not, you know, you're not gonna be able to figure out everything that's going on, but you can figure out enough to live well. And that's sort of my goal for everybody. I am going to stop this and say thank you. Okay. Okay, just a couple things here at the end. First of all, of course, thank you so much to companion medical makers of the in pen for sponsoring this episode. You can go to companion medical comm to find out how your insulin pen could talk to an app on your phone, and then talk to your dexcom CGM help you make decisions about things like dosing insulin on board. A lot of stuff actually, you got to go check it out. It does more than I can just say right here companion medical comm check out the impact. Thanks also to Jenny Smith, for coming on the show. And for sharing her knowledge with all of us. I don't think I've ever made this completely clear. I hope I have. But this isn't an ad like Jenny's not a product placement. Jenny's just the person I love having on the podcast. Integrated diabetes doesn't pay for anything. I just share that with you. Because if you think she can be helpful, I want you to find so integrated diabetes.com to find Johnny. And then I have one last thing. The show is so close to another milestone. I would love it if you guys could share the podcast with just one person who you think really might need it. Love it, enjoy it. You know, anybody? Well, not anybody. Like don't go picking up people's phones and bars and just subscribe. You know what, I'm not gonna dissuade you from doing that. Let me let me restate. I would prefer if you found someone who you thought would really like the show or could use it and got them to listen to it. But if you want to pick up people's phones and bars and subscribe them, I'm not going to dissuade you. I'm going to say I don't think it's right. But I don't feel strongly enough about it to stop you.