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Scott Benner 0:00
You are listening to Episode 287 of the Juicebox Podcast. This episode is part of the diabetes pro tip series that began way back on episode 210. Today I'll be discussing with Jenny Smith, the topic of illness, but not just how to handle a sick day, the flu, a stomach virus, an injury, a surgery, a dental appointment, all of those medical ideas that might require a little more thought. Today's show is proudly sponsored by Dexcom Omni pod and dancing for diabetes. You can find out more about the dexcom g six continuous glucose monitor@dexcom.com forward slash juice box and the tubeless insulin pump that Arden has been wearing for a decade. More than a decade. Ah the Omni pod my omnipod.com forward slash juice box to get a free no obligation demo today. And if you'd like to learn more about dancing for diabetes, it's simple dancing the number four diabetes.com.

This episode is going to have a companion piece. It's the defining diabetes episode on ketones that will have come out at the same time. 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. Don't forget they say an ounce of prevention is worth a pound of cure. So don't forget to wash your hands before during and after preparing food before eating food before and after caring for someone at home who is sick before after treating a cutter wound after you use the toilet changing diapers. helping a child use the toilet after blowing your nose coughing or sneezing touching an animal animal feed animal waste handling pet foods or treats touching garbage and you know how to wash your hands does anybody ever really told you they got a wet them right so you run some water on them warm or cold doesn't matter. Get them wet and put some soap on. vigorously lather your hands by rub them together with the soap on the backs of your hands between your fingers and under your nails. scrub them for at least 20 seconds. Rinse your hand well under clean running water dry your hands using a clean towel.

Jenny let's do a big Sick Day episode. And so I'd like to try if we can to get through sort of a regular sick day like you know, a little beyond the sniffles. Okay, the flu, stomach virus, an injury like a broken bone or something I might have to take, you know, steroid for and then an actual surgery and have you Where do I want to start? You've had a surgery pretty recently, haven't you?

Jennifer Smith, CDE 2:57
I've had multiple surgeries. I've had awake surgeries I've had I've been out surgeries. I don't like surgeries. But I've had though. Yeah,

Scott Benner 3:05
so let's start there a because you got good information about it and be because Arden is gonna have a cyst removed in a couple of weeks. So I want to hear about this. So let's start with something you were awake for. I guess also, like dental procedures would probably fall in this category a little bit, maybe, maybe not,

Jennifer Smith, CDE 3:26
they could they would be a little bit different only because, um, like a dental surgery if you're going to be awake for it like just a tooth removal or something like that. Usually, the awake component to it means that you don't really have to go in fasting or without any food in your system, you know, those kinds of things. If it were going to be I know now, they usually try to take all the wisdom teeth at once if they're going to do that. And oftentimes now I've heard a lot more people being completely put under my son for wisdom tooth, you know, extraction, I didn't I my dentist said Your mouth is not big enough. You need to have your teeth come out but there's nothing wrong with them as they come in, we're gonna take them out. So as my teeth kind of came out and honestly my wisdom teeth didn't completely come through until I was well into my 20s and so they just took them out in office.

Scott Benner 4:31
Me I'm gonna make a note here to myself, because it has nothing to do with this but my wisdom teeth extraction story is absolutely insane. And I will tell it at the end. So why don't we just made it myself. So okay, so if I'm just going to the dentist to have a cavity done or something like that. Not a lot for me to do probably handle things the way I normally do. You know, I guess

Jennifer Smith, CDE 4:55
the big thing to make sure is especially if you're new to having it done is And you've never had any, like pain medication. No, you may experience a little bit of a higher blood sugar, potentially a stress component from having like the novocaine. I mean, that needle is, it's scary, the scary looking needle that they're shoving in your mouth, right. And it doesn't feel very nice either, as they inject it several times. So for those of you know, those people have never had this done, I, it's not very fun. And if you ever do have to have fun, done, it's not a fun thing. But it could cause a rise in blood sugar because of a pain component, because you're just in a setting that's completely not under your control. So, but other than that, yeah, you shouldn't, you shouldn't have to go there fasting, or make any true adjustments to anything. You know, in the future, if you had a second surgery, or a tooth extraction or tooth work, and you knew what happened the first time, you could potentially look back,

and maybe make adjustments like setting a Temp Basal increase, or taking a small amount of Bolus ahead of time to offset arise if you don't want it, or just correct after if you're not quite sure what's going to happen.

Scott Benner 6:13
Yeah, especially I'm thinking if, you know, if you're trying to I'm not usually up for like, run high to avoid a low kind of situation. But if it's an hour, an hour and a half in the office, and it makes you comfortable, you know, let your blood sugar be a little higher for that. And then and then get at it. And because you're I guess too, if you're numb, taking in juice or gel or something that could end up so you don't want to be in that situation could

Jennifer Smith, CDE 6:35
be harder. Exactly. Yeah. So it's been in some things like that, it sure it's a little bit safer to potentially be a little higher, if it does end up rising. I mean, obviously, don't go in at a blood sugar of 250, just because you're scared. But if it rises up, you know higher than you'd love it to be again, an hour, hour and a half of being too high, you can correct it after without worrying that things are going to drop too much. And you can't chew anything, then that's okay. So this

Scott Benner 7:02
is so funny, I'm going to ask you, when I say leave it a little higher, I have a number my head, what's your number?

Jennifer Smith, CDE 7:09
It's a little higher would be like 180 ish.

Scott Benner 7:11
Yeah, I might be insane. Actually. It's like, I was like, he could comfortably already 35 ish in there, I don't want to get crazy, that thing starts drifting to 160, I got a fight with it, then, you know, yeah. But the point is, is wherever you feel like you can reap the control. And if you're real stable, that could just mean like dialing your bazel back a little bit to just let your blood sugar kind of come up a little bit, you might not have to add something to make it happen. Okay, so that's simple. Now, moving on to the kind of the next step of it. Wisdom teeth knocked out cold. Now, I do know this from my son, if you get a good doctor, you're only under a very short time. But when you come back, you are not in any shape to make decisions. Drink eat, my kids said some crazy stuff on the way home from that doctor. And then even once his head cleared out, which I have to admit, didn't take too long. He's bleeding is his mouth is packed with gauze and everything. So I guess we're in are we in that situation, now we're better high than low,

Jennifer Smith, CDE 8:18
it would be better than to be again, in that case, you know, if you went into that surgery to be put out and your blood sugar was nice and stable, let's say 120 even, it should for the short amount of time of that type of a procedure, it should remain stable, or it might climb again from the stress on the body. In the aftermath of that, though, again, it would definitely be better to be a little bit higher than you're typically running. And again, I'm not saying like 180 200 high, obviously, you could correct to bring that down safely. But if you're running like 140 leave it I that there is no detriment there whatsoever at 140 you know, as long until you can take something in or start to eat, or, you know, whatever the dentist told you for when you could start to eat again. I mean, even with my wisdom teeth being taken out one at a time, I think there was I think I had to take it out the first time it was a bottom and it was a top wisdom tooth. And I remember a couple of days of like just soft it was you know where the chewing component just was not pleasant. So having a plan of action to just like any other Sick Day kind of thing, having some things ready to go especially if you're an adult and you're taking care of yourself. You know having some soup or some broth or some jello or yogurt or popsicles or an ice cream or whatever it is that you can tolerate. soft enough don't have to chew it that you can get something in. I think

Scott Benner 9:52
that I think that my as I'm thinking about this happening for Arden next year, probably my plan would likely be higher, not so high that it could get away from you higher, but controllable. And then if it tries to move, just kind of keep tamping it back down a little bit like so that you're in the power position, right? It's not out of control high. So that you're, you're going, Oh, geez, I've used a lot of insulin here. And it's not low, just you know what it tries to come up, push it back down, like, play play that game for a little bit. So you've got the level you're looking for, but you're still reasonably in control of what's happening. I put yourself in a power position there, I think I'm having to handle it.

Jennifer Smith, CDE 10:31
That's correct. Considering the fact that, as we've said before, the littler incremental adjustments sooner mean less insulin sitting there to potentially dump you down to low later. And then a setting where you can't actually take anything in, whether it's a mouth surgery, or this might even move into kind of like stomach bugs or those kinds of things where you may not be able to take anything in or not quite sure when you can take anything in it. It's certainly better to nudge little by little rather than take this big walk thing adjustment and then you can't eat anything to offset.

Scott Benner 11:07
Yeah, I think bumping is the nudging is the way to go. That's I so as I'm considering it right now, for the first time talking to you. And when Arden's wisdom teeth come up, I think that's definitely what I'm going to do. I'm going to shoot for 140 in that range, take your advice over my advice, maybe more like 141 50 and then just keep knocking it down. If it if it tries to run away, basically, just kind of keep tripping it as it tries to get up for a minute. Nope, nope.

Jennifer Smith, CDE 11:35
And find out ahead of time what her favorite soft or cold things are. So you can have them ready. Well, yeah,

Scott Benner 11:40
the pre like, you're gonna have to prepare, right? Like you're gonna write, this is not something you're gonna want to think about after the surgery is over, you're gonna want this stuff,

Jennifer Smith, CDE 11:46
let her sit in the like parking lot at the grocery store. Well, you run in and be like, what did you want to get in her mouth is full of gas. And she's like,

Scott Benner 11:55
I can't get her to pick food when she's not sick or injured. Like we were at the grocery store. Grab a couple snacks for lunch, whatever you're looking for. I don't know, you decide. And I said, How about this? She goes, No. And I went, well, how you gonna tell me the side? And then I say something? He told me? No. I was like, What if I grab something that she has? If you show it to me, I'm gonna say no, if you bring it home, I'll eat it. And I went, Oh, that's a reasonable understanding of your psyche. I was like, Okay, great. So I did anesthesia, impact it all.

Jennifer Smith, CDE 12:25
So some people, myself being one of them. Not only do I have experience with surgery, I have experience with anesthesia, not my body doesn't like it. So again, if you're going into something where you've never had any anesthesia whatsoever before, just be aware that it can cause some like, post operative nausea. Many people get a little bit like woozy headed, I myself just don't tolerate it at all. I talked to the anesthesiologist ahead of time I say, you need to load me up with whatever tools you have. Because I will probably throw up on the nurses when you get me awake. And there's only literally been one time that I had a I had a hernia surgery and umbilical hernia. And, man, if I could carry that anesthesiologist around in my pocket, if I ever needed surgery again, and his little toolkit of medications, he used post surgery, I was golden. I didn't feel horrible. I mean, you know, normal, but not like nauseous, whatever. So anaesthesia can cause some nausea. So just be aware of that. If you know that's an issue, again, talk to the doctor about it ahead of time, there are many different kinds of medications they can use to stop that.

And it depends, you know, on post surgery,

sometimes they'll try to get you to nibble or drink a little bit of something in the post op when you're you know, recovering waking up. You can also be really really woozy, like in and out of like waking up and then getting really drowsy again and that it takes for everybody it takes a little bit of time to wear off. Usually in a post op setting. They'll probably have you in recovery for at least an hour. It could be longer than that, depending on how you seem to be doing. So it's I've always brought somebody along who knows how to look at my palm, how to potentially do a finger stick for me even though the nurses there could definitely do that for you. So my mom has come to a couple of my surgeries. My husband was there obviously for both c sections that I had. So it's really really, really advantageous if you've got a go to person to be there after

Scott Benner 14:49
so funny. I alluded to this while we were recording recently, but you I have a question that's on the tip of my tongue and if you would have paused I would have asked what you said. I'm like, one of us doesn't need to be here? I'm afraid it's me. So I was gonna say, Did you were your pump? And yeah, you know, how did you take control of it? What did you do? So, as long as you were coherent, you were doing it?

Jennifer Smith, CDE 15:15
Correct. As long as I was coherent I was doing it's also really an ahead of time for any type of surgery. I mean, again, like a dental kind of thing. The dentist could probably really care last as long as things are okay and controlled when you come in. They may if they know you have diabetes, they're definitely going to ask when you come in, or your sugars, okay? Are they controlled? Are you feeling well, you know, whatever, they're not going to know anything about telling you to do or dial back or dial up or anything

Unknown Speaker 15:45
that's a dentist,

Jennifer Smith, CDE 15:46
medical doctors, though, will be more involved will be more involved. And they it's really important thing to talk ahead of time, right? Because

Scott Benner 15:56
there as a default, gonna just err on the side of I'd rather see your blood sugar be 300 for the next couple of hours, they're always going to feel that way. They don't really want to be managing your blood sugar. I don't. Yeah, I've seen now in multiple people in my life type two type one, you know, all the way down to my my friend Mike, who was in a, you know, in a coma at the end of his life? And they nobody would nobody? Gosh, I don't want to say they care. They didn't care. But it was a problem. They they weren't prioritizing, I guess. Correct. You know, it was

Jennifer Smith, CDE 16:29
a secondary issue.

Scott Benner 16:31
Yeah, really, it's the think of it that way.

Jennifer Smith, CDE 16:34
Yeah. And they're they're concerned. I mean, from the medical standpoint, in fact, if you don't address the fact of staying on your pump, and keeping your CGM on and whatnot, as long as you can keep them on, there are some medical procedures that include machines in the operating room that could potentially require you to be off of your products, just from a machine. I guess, interference standpoint, there may definitely be some things, there may also be length time of a procedure or a surgical procedure that determines you need to be on an insulin drip versus being left on your pump. So you know, those kinds of things, there is a definite difference. But for shorter lived surgeries. If you go in with your team, and you talk to them, and you say hey, you know, you know that I'm on an insulin pump. If you've got backing of your endo, you can have your endo write a letter of approval for you to remain on your pump and your continuous monitor through the surgical procedure. Your doctor may even include in it, you know, glucose levels, we've, we've discussed, she or he will come in with a glucose level here to here, she or he will have a temporary bazel adjustments set. Many doctors are a lot more conservative than you need to be for surgery. Many doctors will say dial the bazel back by 50% just

Scott Benner 17:59
seems like a lot,

Jennifer Smith, CDE 18:00
again, which is a lot. And for most people again, there are the rare people who have a drop in blood sugar from that stress impact and whatnot. But if it's not common, it's more common for stress to cause a rise in blood sugar. So, you know, dialing bazel back, kind of goes back to some of our other episodes about like testing things, or going into surgery. First thing, they will usually have somebody with diabetes on insulin, have surgery first thing in the morning, they will not push it into the later afternoon or the evening mainly because they'll want you to come in in a fasting state. And it's easiest to get that in the morning for somebody with diabetes. They're in lies, do you know that your maysles are doing what they're supposed to do? If you've got time?

Scott Benner 18:51
Well, yes. Can you imagine to you're gonna need to be fasting for a procedure at 8am and you wake up and your blood sugar's 45 what are you gonna do? You know, you're gonna have to do something and now you have to show up at the hospital and say, I drank juice this morning, and then they're going to boot you back out again and you have to reschedule. So, alright, that makes sense to Yes, I'm so conversations ahead of time with doctors. I'd like to control my own insulin pump. I can do it when I'm on. You know, when I'm not capable. I've got a person here to help me. Here's a letter from my endocrinologist outlining you know, some of my goals for my blood sugar's that they'd like me to be able to stay on my devices. If I'm MDI, I don't want to be on a, you know, on an insulin drip, I want to I want to inject my slow acting, you know, the way I always do, and probably having a little bit of, I don't know charting the word or records to be able to show the doctor like, Look, here's what I do. Normally, I feel confident I can come in and accomplish this correct, yes, correctly important

Jennifer Smith, CDE 19:51
because it eases

their ability to also chart and say, you know, this is the plan of action. This is where You know, this patient's glucose levels, they're controlled, the insulin doses are here, the glucose levels are usually here. This is where they came in the morning of the surgery, even showing them. I mean, every surgery I've gone into they've all the nurses have been fascinated with the continuous monitor. They've been fascinated with it

Scott Benner 20:20
that happened to Arden when she went into the emergency room for that belly pink. And you and I talked that day, actually. Yeah. And the other nurse who was way in charge, super confident and, and competent. And she, when she saw that thing, she's like, this is amazing. And, and I was like, Yeah, right. And she's like, Alright, well, you know, what do you want to do? And I was like, I, you know, I, it was that moment when I said, Listen, I'm not trying to be like, I'm not, you know, I'm not blowing a horn here or anything like that. I'm like, but my daughter is a once he is incredibly stable. On the lower side, her blood sugars. And I showed her like, this is her blood sugar for the last 24 hours. I'm like, I am completely confident that I can keep her blood sugar here. And if I can't, could we just do like she's got an IV and right, you could you could hit her with, you know, yeah, with glucose dextrose. Right. And so that actually happened, we were there for so long that they did have to run dextrose. And it was really interesting to watch, because it took forever to hit, and then it jacked her up. But if you gave her any insulin at all, it went right away in two seconds is very, very interesting to watch how it works. But when going into that scenario, right away, I mean, after we were settled, like I didn't run in the door yelling, she has type one diabetes, and we're gonna take care of it. Like, you know, after we were settled, you know, we were there for a little while. I'm like, Hey, listen, here's the situation, we'd love to stay like this. And that, to be honest, she seemed thrilled to let us do it. It almost felt like, well, then I won't have to do this. So perfect. You know, it was a little bit of that. And okay, that's actually

Jennifer Smith, CDE 21:50
for the most part, what I've actually what I've experienced, there's almost like you, you can't physically see it, but you can see it because with diabetes, we become very intuitive to other people's like, what you can see them thinking you can like hear their gears going right. And every time I've come in for a surgery, I can almost like, see the nurse like go

like their shoulders like relieved.

They're like somebody has control of this. And we don't have to worry about I mean, they will, they will ask where your glucose is, if you do a finger stick or look at your CGM. report it to them make sure that they know and are aware of where things are going. If you did it all make an adjustment to your insulin doses or take anything, make sure to note it to them so that they can chart it. Because it becomes part of the medical record then. But yeah, I mean, my, the, my first child when he was born, we knew it was going to be a C section. And so we we came in planned everything. And the nurse anesthetist who was there during the C section. She actually at that point in time, I had the receiver yet for my deck. Right, I was still using it. And I she was holding it because my husband was like, you know, with me, obviously. And she was amazed by it. She kept like, she's like you changed again. He's like 81 now like, yeah, it'll give you a new number every five minutes, right? But she was like, she was so just enjoying watching. She's like, this is a really steady line. And I was like, yeah, that's what happens when your insulin is dialed in the right way.

Unknown Speaker 23:38
So,

Scott Benner 23:38
you know, to your point, I'm recalling a conversation I had with a nurse in a in a hospital setting. And we talked about this. And she told me that one of the things she dreads the most is running up on somebody who really, you know, doesn't have a firm idea of what they're doing. And she's like, but but it's, they feel like it's working for them. Yeah. And then you feel like you're in the position of explaining to them like, Oh, this isn't Okay, this should be more like this or more like that. She's like, and that's not my job. And you know, and they don't take it well, and they're already under stress over a lot of other things. Right. And now you're you are in the corner of the room going, oh, by the way, you don't do a very good job of taking care of your diabetes. Here's what you should be doing. She's like, it's not the right time.

Jennifer Smith, CDE 24:22
No, it's not at all. In fact, I when we went in for my second son's birth, you know, management had already been established endocrine and my MFM team and already written Jenny will manage, if she's unable her husband is here, he can help her manage, she will remain on her pump, etc, etc. and the nurses were really really surprised by that because they had had a woman the week prior, come in on a pump. And they thought she knew just like, you know what everything I was saying. They said okay, we need you to dial back You know your rates by this much blah, blah, blah, cuz she didn't come in with a plan of action herself. And this woman unfortunately literally didn't even know how to button push on her pump. So I don't I don't know the whole story other than the fact that the nurses and the doctors were like, well, we you can't safely we cannot allow you to stay on your pump. And so she was so excited. She's like, so glad you know what you're doing. Like, this was the scenario we had.

Scott Benner 25:24
I hope hopefully that'll This will give the confidence to other people to make these kind of like pre planning decisions too. Right? Um, okay, so let's, you know, injury. And I only have one example. But Arden got hit really hard in the kneecap with a softball bat in softball once and her blood sugar began to rise almost immediately after the pain hitter, and stayed up for the better part of 18 or 24 hours, she needed a lot more insulin. Now, I you know, I don't think there's a lot to say to this other than there was an impact coming from her body that required more insulin, I gave her more insulin. But that's is that is that a hard and fast rule that pain? Put your blood sugar up in constant pain can hold it up? Or is it that's person the person I would imagine to?

Jennifer Smith, CDE 26:11
For the most part? Yes. I mean, as as kind of just a blanket statement. Yeah, if, if you're in pain, and it's considerable pain, blood sugar's will be higher. If the pain ebbs and flows, you may find a little bit of kind of a drop down as things feel much better. And if it starts up again, maybe between pain medication or whatnot, it may start to escalate again. So So yes, pain, pain is a horrible thing. You know. And that's actually one of the things that I in having had two births. The management of P and post delivery was, most women's insulin needs fall dramatically, after they deliver child and placenta and everything, and all those pregnancy hormones are gone. But after a surgical delivery, like a C section, or a more traumatic delivery, potentially, you may actually see that the stress of that, and the pain that you're in, could leave those glucose levels higher requiring more insulin despite the pregnancy hormones being gone. So that's kind of a similar example or swapping the hormones for the pain.

Scott Benner 27:25
Right, right. And I did see with Arden's knee that when pain issues only taking Advil, but when it worked for she needed less insulin, and then at the end of that Advil if I if I didn't overlap it correctly, then she'd start to go up again. Okay, well, I just wanted to hit that but now we're gonna we're gonna jump into the like the illnesses you know,

Jennifer Smith, CDE 27:45
yet one, can I can I make a comment on one thing, of course, prior to illnesses, since we've been talking about, like, planning for surgery, and all of those kinds of things, if you do have a plan of action, and you know, you'll be going into the hospital. The other things to definitively know is your length of stay.

Or that

okay, because you do have to plan ahead for how much may you need to bring along as far as supplies, right, especially if you're on a pump. If you're on a CGM, you want to make sure that you have enough that you don't have to either send somebody home, the hospital will not have anything to help you out with your pump

Unknown Speaker 28:23
supplies,

Scott Benner 28:24
they're not going to offer you an omni pod, if you know,

Jennifer Smith, CDE 28:26
they're not going to

they you know, I mean, certainly they've got glucose glucometers in the hospital, they've obviously got insulin, if you're really stuck on your type of rapid acting insulin, or another example, and you've got something planned coming up, make sure to bring your insulin to the hospital with you, you may have to give it to the nursing staff, they may have to hold it in in the medical area with your name and label on it. But otherwise, you're kind of going to be at liberty of whatever's on formulary at the hospital and it could be the kind of rapid insulin either you've never used. Or maybe it does doesn't work as well for you.

Scott Benner 29:02
So you ever. Have you ever had an experience yourself or spoken with somebody who's had the experience where they go into the hospital, the hospital wants to leave their blood sugar higher. The people say I don't want that. But the hospital resists. And then the person sort of Mission Impossible style gets insulin to themselves, because I've heard that from a lot of people. Like um, I had, I had to hide my pin from the nurse like that kind of stuff.

Jennifer Smith, CDE 29:29
Correct. Now that in fact, I'm sure she wouldn't mind me answering it because ginger who I wrote my book on type one with Yeah, you know, she is She is an MDI. She takes multiple daily injections. She doesn't use an insulin pump. And her first delivery. That's what she had to do because the nurses were like, We don't want you I don't know where they told her to take her insulin dose down or up by so much that ginger was like, that's gonna kill me. She's like, you can't Do that. And so yeah, she had her like insulin pens in her room with her. And when the nurses weren't in the room, she just dosed herself. Now, am I advocating for that as a healthcare professional? No, I'm advocating that you talk to somebody. But you know, what if in the case of the question that you asked if they're just leaving it, like, so much higher, detrimentally higher than would be healthy for healing. I would advocate for bringing in like, a patient advocate asking the hospital to bring somebody into the room to talk with because there has to be a safe work around that. You're being safe. And the hospital staff knows what you're doing, but that you're doing what you know is better for you.

Scott Benner 30:48
You know how this always happens. It happens in so many different walks of life in and around diabetes and separate the two, especially at school, by the way, with, like how people take care of their children at school. There's this idea institutionally, this is how we do it. And when you come in and say, hey, that's really cool. I'm glad that works for people. I would like to do it like this. No, no, no, this is how we do it. But no one remembers why this is how we do it. Right. Like and it really is. It's the meatloaf story. You know, it's it's that if I ever told you the meatloaf story. I'll do an abridged version of it. Mother and a young girl it's a pot roast actually mother and a young girl and making a pot roast. Mother gets out the pan cuts the ends off the pot roast, puts it in the pan sticks it in the oven. The daughter says Why did you cut the ends off the pot roast? mom thinks for a second says I'm not really sure that's how my mom made pot roast. So they find the grandmother asked her grandmother says I don't know. You're gonna have to you know next time you're at the old age home, find my mom and ask her why. So they visit the old age home they find the mom she's 100 years old, all curled up in a ball. Great Mom, do you remember why we cut the ends off the pot roasts? You know, when we make them? And the old lady thinks and thinks and she goes? Oh, yeah, I had a really short pan. Right? Yeah, you know? Exactly. So. So you don't know why the hospital saying what they're saying? You don't know why the school is saying what they're saying. And sometimes you just have to be reasonable, like you said, and talk and say, I get this is what you normally do. But hey, this is what we do. And look how well it works. Couldn't we? Couldn't we find a middle ground here? Correct. The problem is sometimes that communication breaks down because of I mean, I know on my end, when it would break down for me in the past, it's always emotion, like, you know, you're very emotional and you feel like, oh, you're gonna, you're gonna ruin my kid's life or something like that, or you know, you're gonna hurt somebody and you feel and then you start wrong. And then before you know it, you're arguing. And so you have to really, you got to come at it from a real calm place. But But yeah, I'm not advocating anybody doing that either. I'm just saying that the number of people I know who have done that is more than I can count on my fingers.

Jennifer Smith, CDE 32:56
Something that kind of goes along with that, too, would be sort of an emergent type of setting where you come to the hospital unplanned, like an emergency room, right? a really important thing is that you if you can, if you're awake with it, or somebody who's with you can advocate for you. It's not allowed for them to want to disconnect a pump. Do not let them disconnect your pump. Say that like more forcefully or whatnot. I mean, if you are with it enough, do not let them take your pump, right? Because it they don't they don't know. I mean, emergency department personnel. They're they're great clinicians, but they see a host of things like trauma problems, issues, whatnot, they are not schooled in insulin pump management, they're not. So that's a really, really important one.

Scott Benner 33:55
And these are emergencies that aren't the top end of the emergency like if you're really injured. You know what these people try to keep you alive. You stop thinking about you're in some pop now, but like that, that kind of stuff, right? But yeah, in moments where you're Cognizant, it's, it's a weird thing. Like why would you give over the control of your insulin pump to somebody just because you broke your toe when you're in the emergency room now? Correct. This doesn't make it exactly

Jennifer Smith, CDE 34:17
okay.

That's also the benefit of having a

Scott Benner 34:22
medical ID. Oh, look at Tony is wearing her bracelet, don't you? Oh,

Jennifer Smith, CDE 34:25
it's always on. I think actually, I glued it closed. Because I've lost it. It comes from American medical ID by the way. It's they do a great job. But my class had come like it unsnapped twice already and I've had to reorder the same bracelet. So now it's glued closed. Like they would literally have to cut it off of me to get it off. I was

Scott Benner 34:48
gonna joke that Jenny is making side money, the mentioning America medical bracelets on the podcast, and then she said it broke twice and I thought well, that's probably not what they want people to hear.

Jennifer Smith, CDE 34:59
I'm quite sure sure that it was, you know, my fault of patching it, whatever. But, yeah, it's so actually, it's funny because when I went into the hospital the last time where my kidney stone was not fun

it was a whole bunch of extra visits and whatnot

after, but I told them I was like you, they wanted like all jewelry and like everything removed, and I was like, well, you're gonna have to cut it off then because it's glued together and the doctor was like, Okay, well, we'll just put them whatever it's called, like, Cole ban, or Kay ban or whatever around it, and he's like, you're fine. We'll be fine.

Scott Benner 35:35
Oh, there you go. There's Jenny's had diabetes for 30 years, and she's wearing her bracelet now. Don't you all feel bad for not wearing your I don't even think Arden has one. So I'm feeling particularly bad in the moment. Oh, I'm sorry. You know, it's funny. It's when she gets older. Like, then I think of it like right now she's with somebody constantly. Who knows she has diabetes. It's you know, but it's those other moments. I guess it's the ones you can't plan for, you know,

Jennifer Smith, CDE 36:04
I've got a lot of friends who've gotten tattoos, actually, you know, type one wrist tattoos. I've actually got a good friend in Michigan, who she even talked to some EMTs. And she asked specifically about her design so that she could know from a medical perspective, would this be visible enough? Would this be recognized as a medical ID and whatnot. So there are some beautiful designs that are out there? I just have never one day go that route. I have a tattoo but I just don't have a tattoo on my wrist.

Scott Benner 36:40
Are we sharing where your tattoo is? Or? No,

Unknown Speaker 36:42
it's on my leg. Okay.

Scott Benner 36:44
I have a couple of tattoos. I have one of the top of the crack of might now. I'm just kidding. It's on my shoulder and one of my shoulder one. Well, mine aren't that cool, though. Maybe they are. I don't know. I've had them for so long. That sometimes I look in the mirror and I see it and it startles me. The one of my shoulder happens with him sometimes, like what is on me? And then I realize that 25 years ago I got I've had to and i don't i don't see it because it's behind me. Anyway, okay, so. So let's start with the easiest version of a sick day, right? Like a cold. sniffles a cough like something that doesn't you know morph into something worse, just something that is you're under the weather. How does that does that always present with your blood sugar the same way, like for you personally. All the ads are going to be right here. First up Dexcom, the G six continuous glucose monitor you need it. You want it? You're feeling it with me right now. You've been listening to the podcast for a while you're hearing people making these adjustments to their blood sugar's using the information they're getting back from their Dexcom, you're thinking that's the next level, I want to be at it. And that's just one reason you might want the Dexcom JSX. You also might be looking to be able to watch your child's blood sugar while they're at school or at a friend's house asleep over. Maybe you want to help your sister out he lives halfway across the world. These are all ways Dexcom can help you. But at its core, the Dexcom g six is a beautiful way to see the speed and direction that your blood sugar is moving. You'll be able to see this, of course, as the user on a receiver or on your phone, iOS, or Android. And as a loved one. If the user should give you access, you can also see their blood sugar on an Android or iPhone. What do you do with that information? Of course, in our experience, we use the Dexcom information not just for safety and peace of mind. But for dosing decisions, seeing blood sugars move, deciding how to attack them with insulin or how to maybe take some insulin away when needed. This is where the Dexcom is, in my opinion, exactly what you need. Go to dexcom.com Ford slash juice box to find out more. When you do you'll get yourself some peace of mind. And the ability to look at information about your blood sugar that makes real and lasting changes. improvements, your health and welfare.

The holidays are coming and you deserve a gift. Something it's warm and meaningful, something that will add to your life not take away something that you can get for free. What That's right. You can get a free absolutely with no obligation demonstration on the pod sent right to your house so that you can try it on where it decide if it's something you might like to have in your life. That's right You can get a free no obligation demo of the Omni pod to boost insulin pump sent directly to your house itself. swim with it. I mean, if you're in a warm weather place, you can bathe in it. You can frolic with it, you can play sports with it on. So why not get the demo and do all those things do those life things wearing this demo so you can understand what it would be like if you were using the Omni pod tubeless insulin pump like my daughter has been for 11 years. Every day for 11 years, Arden has been wearing an omni pod. And the addition to her health is immeasurable. The ability to manipulate insulin in forms of temporary bazel rates, extended boluses the ability to keep her insulin going while she's involved in activity in the shower. All times when people with tube pumps have to disconnect doesn't exist with Omni pod. You got to give it a try. Like I said, they're not going to charge anything to get the demo. You don't have to commit to anything. So you might as well give it a whirl, right? Give yourself a little present here at the holidays. Miami pod.com forward slash juicebox. Get that demo sent to your house. It's fun to open up something you didn't pay for. Last thing check out dancing for diabetes today at dancing the number four diabetes.com whip out your little phone there check them out on Facebook, and Instagram. They're on all the Grammy facie things, dancing for diabetes, dancing the number four diabetes.com does that always present with your blood sugar the same way? ache for you personally.

Jennifer Smith, CDE 41:34
For me personally it does. I've found that just the typical sniffles. I'm not really feeling bad. I'm just feeling kind of like stuffed up or something. Typically, I don't see any change in my blood sugars whatsoever. I don't see any change in my insulin needs whatsoever. It's not really until I start feeling sick, where I might feel a little more fatigued, tired kind of rundown, like I could go to bed like at 8pm instead of 1030 you know kind of thing that I like a good thing for me to know that I really don't feel good is that I just don't want to work out because I typically do something every single day for a workout. And if I really would rather like skip the gym, feel like I know that I'm really not feeling great. But blood sugar wise, I've already I already know that I'm not doing great because I'll see an incremental creep use me I usually need about 20 25% more insulin with something that's got me kind of just not feeling the best at all right

Scott Benner 42:38
so with Arden when she has the regular just sick day sickness she needs her blood sugar's are so easy to control those days. I don't like it and not not like I'm coughing and my chest hurts or there's, you know, she's not flying out of my nose or something like that, right? She's a little under the weather. Her blood sugar's easier. Now maybe if I really delve into that maybe she doesn't eat as much during those days. But like there could be another reason that I'm wrong about. But I have heard people say, you know both ways, like I need more, I need less. And so for this right? hydration really is got to be step one in probably all of these right? You have to stay hydrated. Keep food in you. Yeah, as best you can. So you don't get into one of those deficits where you've got a bunch of insulin going and there's nothing inside of you and you drop quickly. It is kind of morphing that from just a regular sick day to a slightly more sick day where you're under the weather maybe have a bit of a fever is the biggest fear. What if I need to eat and I can't or what if I get sick to my stomach and my stomach empties like what do you think of the biggest fear around being sick as being

Jennifer Smith, CDE 43:49
I would say it's more the it's not like the congestion, the nasal the bronchitis, the ear infection, that's usually not it's more the bugs that hit the digestive system that are the fear for most people. High blood sugars. Most people will realize that they need more insulin, whether they're just throwing insulin and correcting because they're staying high or they actually intuitively are like huh, I need to bump my basil up I'll use a Temp Basal here because I obviously I'm just running across the board high. That's not so much the worry it's more the Gosh, I really don't feel very good things could be coming out one or both ends and nothing really seems to be sitting well or you have consistent enough nausia that you can't really do more than a sip every hour. Yeah, those are more of the bugs that worry people. So I mean there are there are some kind of hard and fast rules. You know if your blood sugar is on the lower and declining or dropping and you can catch it ahead of get being to low you can if you're using an insulin pump set at Temp Basal decrease about 80%, or about two hours, okay, so if you're really nauseous to the point that you can't take anything into stop that drop off, you can decrease bazel enough again, before you actually are too low, to stop the drop and sort of curve you off until you could get a little bit of something. Usually extreme nausea doesn't last like nine hours at a pop, it kind of ebbs and flows through a stomach bug. So, you know, at some point, you could get in something even in the case of honey, you put put honey in the gum and sort of just massage it in, you don't even have to swallow it, but some of it does start to get absorbed in you know, through the mouth,

Scott Benner 45:49
right. So it's funny, so you just described exactly how I help Arden sleep in really long. So on a on a Saturday, if she you know, she goes to bed late, and or she's been really exhausted all week or something like that, this this out is going to be one of those like, she's got a lot going on this week. And I know she's going to sleep in, there's a moment, like in the in the beginning of the day, the six o'clock 789 o'clock hour, it's like a 50% decrease in her insulin. And that keeps her at 90, right. But if she starts power sleeping into that 10 o'clock, 11 o'clock, 12 o'clock, I sometimes have to go down to like an 80% decrease, just because everything in her body that could possibly keep her blood sugar up is gone. Now it's just, it's really gone. She's been asleep for 12 hours, you know, 10 hours, it's really gone. So I've learned that I can't take all the insulin away. Because if I do that, she's gonna jump up or be really high two hours after she wakes up or something like that. So you have to leave summon, but almost not enough for it to impact the moment at all just for to help overall. And right and then from there. It's great. I mean, the idea of the honey in the cheek, something that doesn't make it to your stomach, because the the lining your mouth is really absorbent for things It is so your cheeks under your tongue, right? Yeah. Yep. That kind of stuff. So you can get sugar in there without actually swallowing? I'll tell you, I'll tell you two in a panic situation, if you don't have anything, even table sugar, you know, you can dissolve sort of in the saliva of your mouth and leave it there. Yep, yep, there's a lot of ways, but you're going to have to get creative unless you're planning to head right, and you have sports drinks that you can take these kind of micro steps off of throughout the day, you know, yeah. But all we're talking about here is, is maintaining that balance with the extra variable of your stomach, maybe being sour or incapable of holding the fight, right? When it

Jennifer Smith, CDE 47:53
comes to also prepping similar to other illnesses and whatnot, kind of, you know, like the discussion about mouth surgery, just prepping and making sure you've got some things on the shelf in your house, kind of, if it's popsicles that you always keep in the back of the freezer that have a sticker on that, say, don't touch Unless, you know, sick days, six days stash or whatever it is, there's actually a really good electrolyte. It's not pre mixed, it comes in like one of those little two, not tubes, but like packets, kind of like Crystal Light, almost. It's called drip drop. That one works really nice. I think each packet, if you consume the whole thing, it's only about like nine or 10 grams of carb. But the nice thing is that it's got the electrical light component to it to for replacing what might be coming out.

Scott Benner 48:40
Yeah, um, so just some options. It's very dense with what you need to and I know about it for a completely different reason. But when Cole was recruiting for college, he got stuck at this three day event in August. And it was like 115 degrees. And he was playing baseball for three days in a row trying to you know, it's like, look at me, someone take me on their damn team. But he was downing Pedialyte throughout the day to stay in that. So yeah, it is really impactful.

Jennifer Smith, CDE 49:11
The other component to stomach bugs and adjustments would be if you are able to take in a little bit usually because of stomach bug means that you're not absorbing well. digestive leave, we really expect that you're probably absorbing only about 50, maybe 60% of the carb amount that you might be taking in one don't Bolus until you know that it's going to stay down. So in this circumstance, you're not doing Pre-Bolus thing at all. You take the food in you make sure it's gonna sit there it's gonna stay you Bolus only for about 50% of what you actually consume. This

Scott Benner 49:45
is survival situation, right?

Jennifer Smith, CDE 49:46
It's a survival and again, if you see it coming up, sure that's where that like little bump nudge, kind of with a little bit more, maybe a little bit more whatnot, but be conservative to begin with because stomach bugs don't last long. There. Not like the common cold five to seven days, maybe even 10 days, usually stomach bugs are gone within about a 72 hour time period, you may still have decreased absorption for days after you're feeling better. So don't don't think it's odd that you might be dropping a little bit low when you're back to eating what you consider normal food after meals, it might just be that your digestion is just not up to par yet. So

Scott Benner 50:26
if you're a person or a parent of someone who is prone to stomach issues, is having a prescription on hand for so friend or something like that. Is that a good idea? Like an anti ship medication? Yep. Yep, we'll talk about that.

Jennifer Smith, CDE 50:41
There's another one that's over the counter. It's called Emma trawl, m e, m, e, tr, O L, I think it comes in a little white bottle, it's got a rainbow on it. That was something that the my second. My second wisdom tooth extraction, the dentist actually recommended for me, okay, um, for nausea. So and it seemed to work really well. So

Scott Benner 51:06
so and if I'm on MDI, and I have this illness coming up. How do I cut back my, my slow acting insulin? Is it a percentage do you think? Or where do I start to,

Unknown Speaker 51:17
you know,

Jennifer Smith, CDE 51:18
it again, in the circumstance that you wake up in the morning throwing up, or, you know, just not feeling the greatest and you're taking your basal dose in the morning, you can adjust it absolutely. And you could take it back by 10 20% as a starter. If it's really considerable nausea, and you're not really sure that you're going to take anything in, you may cut it back even a little bit more than that, and then just cover with boluses of your rapid insulin, if you are riding higher through the course of the rest of the day, but don't take an additional dose of your long acting insulin from what you missed. From the initial dose to make. Don't just wait, the next time you need,

Scott Benner 52:01
you know, so, you know, when you're talking about taking care of kids. I mean, anybody who's a parent who's had a child is sick, you realize, you know, for sure, like everything in your life stops, right? You know, it work doesn't matter. You know, the television show you really want to watch tonight disappears out of your life, you know, the weather doesn't, you're, you're keeping your kid alive. But But what if I'm an adult, and I'm alone, right? I'm living by myself and I have type one diabetes. I'm sick, and I'm exhausted. And I know I am going to fall asleep and stay asleep. Like, what? What do I do before I fall asleep because that kind of illness you see people sometimes 10 hours there, they're out like a light, right? And it's the kind of illness in the in the stress on your body. You might not wake up if you have a problem. And you don't want to be in that scenario. You don't even want to wake up with an extremely low blood sugar. Like imagine having a 40 on top of a stomach virus. Right? It's got to be horrible. I'm guessing. So do you ever? I mean, how long you been married? You ever live alone? Like what would you do in that scenario? Would you

Jennifer Smith, CDE 53:06
I've personally never lived alone. I either I went from my parents to having college roommates, to having off campus college roommate. To then I think I lived alone for about a month between my college roommates moving out graduating and then getting married to my husband,

Scott Benner 53:25
your husband should take a lot of comfort in the fact that your face did not go Oh, geez, I do have to get divorced. Isn't that what's that saying? No, no. Jenny has to fly.

Jennifer Smith, CDE 53:38
I've done but I've traveled alone. Right? You know, so in that circumstance, too. There are always like safety pieces, you know, and I, when I travel alone, I actually set my CGM alert for a little bit higher. I'm over in the overnight time period. Just because I want to know sooner than if my husband was sleeping next to me cuz he's usually the one that hears it before I do.

Scott Benner 54:03
I got hit the shoulder last night. Don't you hear that? And I'm like, No, because I'm sleeping. Like Yeah, beeping I was like, Alright,

Jennifer Smith, CDE 54:11
but for those living alone, I think some some strategies again, this would be a staying safe, by being potentially a little bit higher is actually better. So if you know that you are just like done and you are out and you are going to go to bed and you may not be up for the next 1012 hours. Just set a Temp Basal decrease. Or again, if you're going to bed at night, and you know that wake up in the morning at six o'clock is probably not going to be until 10 o'clock because how horrible you feel. Maybe you take your basal insulin injection dose down a little bit. You know, I mean, there's safety things. Yeah, you may wake up higher than you want to be. But it's in this scenario of being alone. That would be the safer case. I'm not advocating obviously for waking up at 200 or 300. or whatever. But yeah, you wake up at 180 instead of waking up at 100. You know what, at least to see?

Scott Benner 55:08
Well, I mean, the idea is to get through this unconscious time period and back attack the conscious safely. Correct. That's what you're shooting for.

Jennifer Smith, CDE 55:16
The other component too could be, you know, setting alarms on your phone, or setting an alarm clock in that time period, just to wait. I mean, as much as you want to sleep and need the rest, because you don't feel good. If you really are worried because you already took your basal insulin, and you can't adjust it now. Or you're getting to that point of just needing to lay down and you just had a meal, and you're not quite sure what that bolus is going to do for you. set an alarm.

Scott Benner 55:43
Right. Yeah, I mean, everybody should have an old $8 windup alarm clock back and pull out of a drawer and set across the room so that you can just reach over and touch snooze on your phone. Yeah. And, and, and get out of it that quickly. Okay. Well, that's, that's really, I think we're finding a lot of good ideas here. Um, so real quick medications around illness, cough medicine, you know, they make some without sugar, I guess. Or I could Bolus for like

Jennifer Smith, CDE 56:10
they do. It's called diabetic tostan. diabetic testing.

Scott Benner 56:14
That's what it's called. We really just called it diet testing. But all right, I mean, I'm not a PR department over there.

Jennifer Smith, CDE 56:21
It's cough syrup that doesn't have any sugar added to it whatsoever does the same job but doesn't have any, you know, glucose raising component to it.

Scott Benner 56:31
Chris Rock in his stand up, it was like, rub some tussen on it was that my mom used to say Robson? Was that

Jennifer Smith, CDE 56:37
Who? I don't remember figure

Scott Benner 56:38
out? I'll figure that out. Okay, so diabetic tossin was, what about is there? I mean, steroids. steroids are going to push my blood sugar up the entire time they're in the body, right?

Unknown Speaker 56:53
Correct.

Jennifer Smith, CDE 56:54
Yes. And the increase can be considerable, depending on the dose. So injected, injected steroids, like a cortisone injection into a joint or something like that, those will cause considerable increase in blood sugar, definitely within the 12 hours after, you're going to need an increase at least 50%. Many times people see 100% increase. And then that that increase will last for a couple of days until the dose from an injection sort of starts to dissipate. I mean, the impact of it stays within the body, but the impact of the actual it's called, you know, cortisone, or whatever else has been injected on what other kind of prednisone or whatever it might be, it's going to dissipate enough that you're going to see the need for that increase in in bazel dose come back down. I, you know, it's it's not odd to see 100% more 150% more bazel dose, especially many people who are also paying close enough attention will often also need an adjustment down in their insulin to carb ratios, the correction factors. A, as far as oral steroids, depending on the dose, and again, on a potential hard stop or a taper of the dose. Most often, those are people who have like a Bronxville illness, and they have like a background like asthma or some other type of lung condition that the doctor really wants to attack the illness to prevent pneumonia or something else, you know, progressing. Those types will usually again, increase the need significantly, and the insulin to carb and the sensitivity factor will need to be adjusted.

Scott Benner 58:48
Okay. And I guess how to medications that may have a side effect of nausea, you should be careful about if they want you to take them with food, give yourself a chance to not show up, you know, make yourself nauseous when you when you might need to hold something down. And what I double back a second to the idea of an alone adult or even a kid whose parents, you know, might feel like it's slipping away, like, when do I it's so funny to ask this question, because we spent some time talking about the fact that hospitals don't seem to particularly you know, value, like your blood sugar that much but the winds the moment when you wave the white flag and go to the hospital, like like when am I like, you know, not that you should be running every time you're sick. And by the way, I feel terrible because some people get sick more frequently than others. I can. I can count on two hands. The Times both of my children have been ill. Arden doesn't get sick much at all. Which by the way, too, for those of you who do, what a horrible joke that is from nature, right? Your immune system was strong enough to beat the crap out of your pancreas. But it can't make bronchitis go away. You're like, Whoa, come on, man. But, but so when do I like what's the Mendoza Line four when I think I better get the professional help. And why do I want to do that? Like, what is it I'm avoiding,

Jennifer Smith, CDE 1:00:06
that kind of comes in. And I know we had a whole discussion, an episode all about ketones and how to look at that and whatnot. But that kind of brings that into the picture as far as blood sugars and or hydration. And if you are ill, and you're really not feeling good check ketones, you know, because in the case of moderate to high ketones, those often especially if you are not feeling well, and you can't get enough hydration and fluids in, you may very well need to go to the emergency room. In that case, it's just your blood sugar's may not look like high enough to say, Gosh, I this is really bad, I have to go on both, you know, to the emergency room or the hospital. But if your ketones are at that moderate to high level, you definitely need some help clearing those or you're going to be in trouble.

Scott Benner 1:01:03
And IV would help with that, right as

Jennifer Smith, CDE 1:01:04
an IV would help with that. Because they're not going to make you down a whole bucket of water via your mouth. They're going to put an IV in and they're going to push it in through your vein. Because if

Scott Benner 1:01:16
you could, you would, too. And and I know I know that because and I think I've told this here before but Arden woke up one time with should have bent Canyon one bent Canyon, like 14 years is amazing. But she was pretty. She woke up with a higher blood sugar. She was nauseous. I tested her ketones, they were high. And I said to her, I'm like, Look, here's your options. Now she wasn't sick, like you know, I mean, shouldn't have a stomach virus. I said, You pound this water down. I crush you with insulin. And you promise me that you can eat something to stop the fall. Right? Like and or we're going to the hospital. And and she's like, uh, she took a bottle of water for me and Arden is I've mentioned this here before she's a princess slipper. When she drinks water. It's like a little bit a little bit. She took that bottle of water. And she pounded it all down. And she was like, Is that good? And I went, yeah, you can sip it. The next one, you know, and we got like three bottles of water in or over two hours, we made a big bolus. she, her blood sugar broke, and her ketones began to fall. And we caught it with a little bit of we caught it something and that was it. It took us three hours to not go to the hospital. But she was willing to do it. And it was hard. She told me later that drinking that water was incredibly difficult because of the pain she had from the elevated ketones. Yeah, she was she felt very nauseous from it. Obviously, she wasn't sick. But yeah, at some point, there's gonna be a safety issue, please don't get to the point where you're calling an ambulance, you know what I mean? Like, like, you might have to give up at some point,

Jennifer Smith, CDE 1:02:54
right, you're doing this kind of, it kind of brings into it. A component of like nausea in pregnancy can be a very considerable thing for some women, especially in early pregnancy. So if you have significant enough nausea, and you're not literally able to take things in, or you've gotten to the point of actually vomiting, because of the significant nausea, it's always better to try to go and get at least IV hydration so that you don't run into an issue of ketones even though blood sugar levels may not be elevated in that circumstance. You could develop ketones mainly because you're just not keeping anything in. And that's very, very, very bad in pregnancy.

Scott Benner 1:03:46
Can I ask you a question? And I don't usually put you on the spot for this because it's a massive question about how to do the podcast. When I put this episode out, I was thinking to put the ketone, defining ketones right with it, you see them as these are companions to each other. Okay,

Jennifer Smith, CDE 1:04:00
absolutely. That's a great idea. I will definitely do that, then.

Scott Benner 1:04:04
This is usually the time where I say is there anything I didn't say that I should have said?

Jennifer Smith, CDE 1:04:08
The only thing I would say is for all of this, the biggest thing comes from like my years with Girl Scout, be prepared, right yet to be prepared. And one of the best things I can recommend doing is having you never know when you're going to have to run out the door to like an emergency, like situation, right? Or even in the case of I know this isn't illness specific, but this is like just being prepared like you have to run out of the house because I don't know your stove is on fire. Right? I mean, if you have a diabetes, emergency bag packed, get a backpack, a red backpack, cheap, go to Target or wherever get one put in it. All of the things you could potentially have to take with you quickly out of the house. Hmm, it'll be a lot easier in a an illness emergency especially, especially somebody has to take you out of the house, right? If you got stuff pack to go at least you know you've got, you know, a set change and extra test strips and batteries and whatever they're all in.

Scott Benner 1:05:17
So Jumanji situation when giant vines and lions are going through your living room and you really need to get out, you want to be able to grab this bag. Correct. And at least have it pack somewhere and no, it doesn't have to be hanging by the door chasing

Jennifer Smith, CDE 1:05:29
you through the kitchen. Whatever you very mean in that movie. He were the

Scott Benner 1:05:35
Robin Williams and now I'm now people are like Robin Williams wasn't in that movie. That was the rock. How did you confuse those things? And who is Robin Williams, but there's been two Jumanji movies, so young people, please leave me alone. I want to close by saying that as we were talking, I was proudly struck by how much of what is normally spoken about on the podcast translates very well to this idea of sick days. That, you know, obviously there's heightened scenarios, but that the tools you use really aren't much different. You might use different ones in different times than normal, but, but it's not like. And the reason I say this is because when people are trying to figure things like this out, I oftentimes see them believing that there's some extra special knowledge that they don't have about diabetes that applies only to the day you're sick. And I still think that one of your greatest diabetes tools is common sense. And so I think that, you know, we obviously broke things down a lot more granularly here, but it's still the tools. It's the pro tip series right now applied slightly differently. So right um, I thought this was really appreciate you doing this. And we talked so long that I can't ask you to define Lada so I'll do that next time. Okay, so that you can go, I will say thank you.

Unknown Speaker 1:06:53
You're welcome.

Scott Benner 1:06:56
Huge thanks to Jenny Smith, who of course, you can find out more about at integrated diabetes.com links in the show notes. And of course Dexcom on the pod to dancing for diabetes for being long time. heartfelt sponsors of the Juicebox Podcast, go to dexcom.com forward slash juice box to find out today about the G six continuous glucose monitor. Or go to my on the pod.com forward slash juice box to get your free no obligation demo of the Omni pod sent right to your house, they'll mail you a tubeless insulin pump to try yourself. And of course dancing for diabetes on Facebook, Instagram, and at dancing the number four diabetes.com. And if you're just finding the Juicebox Podcast now welcome shows been around for five seasons. And not like you know other podcasts are like they put up like five episodes like that was a season, a season of The Juicebox Podcast is 52 weeks long, you might want to call it a year, and you're gonna get two episodes. In every one of those weeks, there's always going to be an interview with someone who's living with type one diabetes, and then more of a management episode. I call those defining diabetes, diabetes pro tip. Ask Scott and Jenny. These are all episodes where we break down more management ideas. So find those and check them out. The feedback I get from listeners is really encouraging. As a matter of fact, I will go right to a review right now just whatever the most recent one is. See, there's a bunch of them here, here from November 30. This podcast should be prescribed to all diabetics at diagnosis. I have read books, scoured the internet and attended hours of training at the end Oh, and I've learned so much more from this podcast series, I cannot recommend highly enough to check out the podcast and maybe you'll have a similar experience to this person who said life changing podcast. And I am not exaggerating. Within two months, I lowered my one C from 7.4 to 6.1 with obvious and easy to follow instructions. All right now I owe you a story about my wisdom teeth being pulled. So I grew up incredibly broke. It was me my mom and my two brothers. And my mom had a job that I think at the time must have paid about $4 and 85 cents an hour. So we didn't have like fancy stuff like you know, health insurance and dental coverage and stuff like that. As I'm growing up 1819 My friends are having their wisdom teeth pulled out. I just keep doing what poor people do all over the world. I ignore the fact that I have wisdom teeth and that they're probably eating to come out. But then one day I'm 20 or 21 they really begin to hurt. So I go to a local dentist's office, you know have to go in there with my head down. I don't think I've been to a dentist and forever and I'm like, Look, I don't have a lot of money but I'm having pain and I was hoping you could help me. So he looks and says it's almost like he ignored what I told him about. My money situation is like, Oh, those wisdom teeth have to come out, I'm gonna give you the number of a, an oral surgeon, he can take them out for you. I said, Wait, like in the office or hospital, he starts telling me about, you know, procedure, they'll be taken out, said, Man, I can't afford that I don't have any insurance. And he says, well, they have to come out. I was like, Well, how much do you get to pull a tooth? And he says to me what I'm like, like, if I had to pay you cash to pull out a tooth? How much would you charge me if I didn't have insurance? Like I says, $50? I said, $50 a tooth? They said, Yes. I said, Okay, I'll give you $200 to plot my wisdom teeth do it right now. Well, he's horrified, obviously, not how things usually go. And I'm just very insistent, I'm like, Look, if you think these really have to come out, this is the only way this is gonna happen. I cannot afford to go to this oral surgeon you're talking about. So he numbs me up. And calls in a dental assistant, who I swear to you stands behind me above my head, as I'm all the way back in the chair. And he takes his two palms and puts them on my forehead. And his job is to push down on my head while the dentist is pulling out the wisdom teeth.

And boy was that unpleasant. The pulling of the teeth, even with the guy like laying all of his weight on my head was pulling my head up off of the chair. And at one point, I could tell by the dentist's face, he was horrified. He was thinking to himself, I should have never done this. I should not have gotten started with this. But it was too late. You know what I mean? We were in for a penny in for a pound at that point. And he had one of the teeth out. So he's pulling the guy shoving down in my head. I'm trying not to freak out. And next thing I know, we're done. All four out. I'm late 200. He sends me out the door with the great medical advice of don't go to the gym for a couple of days. And that's how I got my wisdom teeth taken out. My son got to go to a beautiful dentist's office. It was put to sleep and a wonderful slumber woke up and he didn't have teeth anymore. I tried to share this story with him, but I don't think he has any context. So I didn't seem to penetrate him. Quite the way maybe would somebody else penetrate is not a word I met penetrate. But I don't have the heart to go back and edit it out. So let's just call this the end of the podcast. Don't forget, oh, the defining diabetes episode about ketones that Jenny mentioned is out right now to well worth your time. If you're thinking about sick day treatment. I hope you don't get sick. Don't forget to wash your hands. cover your mouth when you sneeze into like the you know he's supposed to do in your elbow now, right? They changed the rules on sneezing. You know, when I grew up, you just sneezed on your hands but turns out that's not a great idea. retrospect It was pretty easy to figure out. I don't know why we were doing it. But you know, the 70s whatever. Get out there. Stay safe. Get a flu shot. If you're going to get a flu shot. Do your best. Try not to touch your face. Oh my God when you're on airplanes, right? Don't breathe. Just trying to breathe on an airplane. Just hold your breath for that. Just hold it in as long as you can on the plane. Alright guys, good luck. I hope nobody gets sick if you do. I hope this episode helps.