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Scott Benner 0:00
Hello, everyone, welcome to Episode 311 of the Juicebox Podcast. Today's episode is a pro tip. So you know what that means. It's not just me today and a guest, it's me and Jenny Smith. Today Jenny and I are going to talk about long term health as it relates to type one diabetes. This one's a little less pro tip and a little more conversational. The information rises to the level of pro tip. But the style of conversation is more like Jenny and I got together as friends and I said, Hey, tell me your thoughts about this. And then we chatted about it a little more laid back a little more conversational. But the information is definitely something you want to have in your tool belt. And that's why this episode is part of the diabetes pro tip series that begins back on episode 210. This episode of The Juicebox Podcast is sponsored proudly by dexcom, makers of the G six continuous glucose monitor. And of course, on the pod, the tubeless insulin pump that my daughter has been using for 1112 years, a long time. It's been an honor every day for that time, must be good. I'll never forget the day I was sitting in a hotel lobby when a person asked me what's next for your podcast? What are you going to do to innovate and keep it moving. And I said, I'm gonna do a pro tip series, I think I have all these ideas, and how to bring them all together and really talk through them with somebody equally knowledgeable, but who will come from a different perspective. And I had that person in mind already. That person was Jennifer Smith. Because Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Plus, she's had Type One Diabetes for over three decades. And bonus, I like Jenny. I like the way she talks about type one. It just, there's a goodness about her. She seemed like the right person. And she certainly has been. It's been over a year since the first pro tip episode came out at Episode 210. And today is the 17th. In the series, I believe you got to go check them out. They're all listed as diabetes pro tip is a colon and then the titles afterwards. One last thing you know what it is? Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, please always consult a physician before making any changes to your health care plan or becoming bold with insulin.

Jennifer Smith, CDE 2:47
What are we doing today?

Scott Benner 2:48
We are going to do a pro tip episode that you suggested and prevention of long term complications you said and you said What does optimizing glucose long term do for keeping things healthy? So I feel like what you meant by that is below less variability not low but in you know, lower than what a lot of people go for less variability, lower standard deviation, how is that going to help you throughout a lifetime? And so I feel like between that, and some other safety ideas that I'd like to bring into the conversation. I think we're gonna have a good a good talk here. So I guess first, why don't we talk about a little bit through time, right? Where does everybody and by everybody, I mean, doctors, where do they get the information that they put on their patients? You know, I'd like to see you have an A one C of x. Does that come from the American Diabetes Association? Do they set the tone who sets the tone for what we should be shooting for? Because somebody does it?

Jennifer Smith, CDE 3:51
As far as targets? You mean? Yeah. Yeah. So I mean, well, targets calm. It's funny. I just had a conversation with somebody who listened to the podcast, and I had a first visit with her just before this. And she asked the same exact thing. She's like, I'm getting all of these different targets from different people. And she's like, I don't even know what to believe anymore for a target. She's like, I know where I feel good. I know where I kind of want to be, but what am i aiming for? And I said, Well, there are a couple so the American Diabetes Association aims for your post meal target under 180. Okay, it comes from the American Diabetes Association, through research and gathering of all of this information and, you know, whatnot and looking at complications down the road. cumulatively. They aim for what less than 180. Now, the American Association of clinical endocrinologists recommends less than one six.

Scott Benner 4:48
So less than 160

Jennifer Smith, CDE 4:50
less than 160. Okay, so there are two high in the ranks of diabetes management. Yep. That are different. Already, right. And then we bring into the mix. Well, what are recommendations even further than that, like pregnancy? pregnancy recommendations, you know, are for the most part under 120, fasting under 100.

And post meal no higher than 140.

Scott Benner 5:20
So M is what I'm hearing good good for the shift. Oh, fusion.

Jennifer Smith, CDE 5:24
Yeah, confusion entirely. And then I had a woman in a couple of years ago postpartum, I had her visit with her. And she's like, so I was aiming for all of these targets in pregnancy to keep my baby growing healthy, and myself. And she's like, and then my doctor tells me to loosen up my target in my palm, and tells me I don't have to be so you know, quote, unquote, tightly managed, and she's like, sick, I want to ask your opinion, Jenny's? Like, why wouldn't I want to stay this tightly controlled if it was good for me and pregnancy? And these are targets that people without diabetes? maintain? Because their body does what it's supposed to do? Like, why wouldn't I want to maintain this? Whether I'm pregnant or

Scott Benner 6:03
not? Yeah, yeah. So here's right here. Exactly. And here's what it's making me feel like, so much like, with everything about diabetes, when you try to give someone like this just, I don't know, this is how things are right? Like it 181 6120 whatever anybody ends up saying, that's not personal. And and personal, between should be consideration should be you, your intent, your involvement, your intellect, your understanding, then it should be, am I injecting? Am I using a long acting insulin that's been I was made 20 years ago, or my using one of them that's, you know, been made more recently that people find more stable a lot of the times, am I using a pump? Do I have a glucose monitor? Is that you know, is it a Libra? Or is it a dexcom? Is that the G six? Or is it the G four like, it would seem to me that all of those variables would would make it more or less likely for me to be able to maintain targets that are lower or higher? Right? And so then you get the doctor, like what you just said about the pregnant person? I feel like that doctor was like, Look, you must have had to have killed yourself to keep your blood sugar that low. Right? Like, obviously, it ate up nine, you know, nine months of your life, you did nothing but keep your blood sugar in check, have to pay and watch television, that must have been your whole line months, right? Like, like, you're talking to a guy in 1920. It's like, you know, you didn't even have time to make me my pot roast. Like, like, like that, like Reagan old time idea, right?

Jennifer Smith, CDE 7:41
And now you come into the office and You look like you've got baby spitting your ear, you look like you haven't slept or combed your hair. So let's loot some things. Sure. Right.

Scott Benner 7:50
Right. I think that what would make your day easier is if you were less healthy. But it's not it becomes about and I get that right? Like, I think that out away from the ideas that we talked about on the podcast. Maybe that's real. Do you know what I mean? But when you start telling people, we, when I started asking people, you've been at this for a while now six months, eight months? Is it that hard? They say no. Like most of the people, I don't want to say most of them everyone I've ever spoken to who's picked up the ideas of the podcast, put them in practice, and gotten to the point where it's just second nature. They don't think about diabetes, very much these these targets are meaningless because you get to a spot you stay at that spot. If you leave that spot, you know how to get back to that spot? Right? That seems like it to me, honestly.

Jennifer Smith, CDE 8:40
Right. And from the standpoint of, you know, prevention, I mean, that's the that's one of the biggest things that brought out beyond Well, here's your insulin, here's how to inject it. And oh, by the way, insulin can cause your blood sugar to go too low. complications are always within the first like, new onset diagnosis, discussion. Always something about complication, right. Always, like you have to control things. I love that word control because like, like a moving target and control.

Scott Benner 9:11
Not only that, by the way, it gives you the impression that you're going to be out of control and it's your job to control the chaos.

Jennifer Smith, CDE 9:17
Correct. Right. Exactly. It's like your job to hurt all of the million cats in your yard with no fences. Yeah, right.

Scott Benner 9:23
What if I just didn't let the cats in? How would that be?

Unknown Speaker 9:26
How would that

Jennifer Smith, CDE 9:28
play? Yes, exactly. So you know, the prevention of complications that I mean, there's no, there's no set solution, really, on how to 100% prevent complications. In research. We've seen people with many years of diabetes, some of them poorly, you know, managed, some of them tightly managed, and complications can start for people at different points of time. And that makes it seem like well, gosh, I'm just gonna throw my hands up in the air if I can't 100% prevent anything. But what we do along the way makes you feel good. on a day to day basis with tighter containment of things overall, yes, we are likely 99% likely avoiding the complications down the road, right at 1% that something could happen. Sure, it could be there. But I don't think there are many things in this world that are 100%.

Scott Benner 10:29
Right? perfection. And so to your point, it's, it's presented incorrectly to people. It is like right away, like, you know, it's not your goal not to die. Right. It's your goal to live really well. until you die. Right. Right. And and if you can extend those years, wonderful. But you know, it's just and you just said to about how people feel? I've been talking about that a lot lately. I don't know why people don't think about that. Like just how they feel every day. Like, you know, are they tired? Are they sluggish? All the stuff that we've spoken about over and over again? Why is that not important to them? And I don't think it's not, I think they find it to be something they can't impact, which isn't true. It just isn't like there are times there are times genuine, I'm afraid people will realize that when I keep saying over and over again, it's about timing and amount and common sense. They're gonna go, Hmm, I don't think I need to listen to that podcast. That guy might be right about that. Like, why don't I just tie my insulin better? And when I see something happening, go, Hmm, that makes sense. I should do this now. Yeah. Right. Because, I mean, honestly, there's no pot, if you guys all figure it out, the podcast is over. Basically, I, you know, obviously there'll always be newly diagnosed people who are going to get this terrible information and start down the wrong path. I just I want I want people to think more about how they feel. And I spoke about this in my talk this weekend. And I've said it here before, too, but you have to, you have to believe that if your blood sugar is constantly high, you're altered. You just are like there is a person

Jennifer Smith, CDE 12:09
without short term and long term.

Scott Benner 12:11
Yeah, there's a person you would be intellectually articulately that you don't get to be when your blood sugar's high, or crazy low or bouncing around, right? Because your brains always just, it's, it's, it's just, it's not where it needs to be.

Jennifer Smith, CDE 12:27
I don't know. And within that, even within that day to day feeling, are those behind the scenes. Unfortunate what's happening in the body that you aren't feeling? Like, we know how high blood sugars make us feel. And if you're paying attention, you know, the containment of them, you get out of that you can think better, you can act better you can do the things you enjoy doing. But behind the scenes, internally, what's happening with better management is you're not causing damage to cells. You know, I mean, especially heart disease, I mean, heart disease is a huge component that we have to take into consideration. But it's not like it has to be there in your brain every single day. If you are managing the blood sugars, you're also managing a healthy heart. You're also managing healthy kidneys, healthy nerve cells, healthy eyes, you're managing those internal pieces that until they are damaged enough and give you indication that there's a problem. you're managing that along the way so that you don't get to the end of the road and have heart disease or kidney problems or whatnot, right? Yes.

Scott Benner 13:37
Oh, and where do you stand? Have you ever heard me explain how I think of it with the sandblasting? Have I ever said that? Because here's the place to say if I've ever said it to you, okay, so the way I think about high blood pressure, high blood sugars, and back when my kid was little, and I was looking for motivation, like seriously, like, what, what's gonna get me up at two o'clock in the morning to correct a 150 blood sugar. But when my doctor is telling me That's okay, like, what's the motivation. And whether I'm right or wrong, technically, in my mind, it feels like this. My body is built to withstand a certain amount of certain content of sugar, glucose in my bloodstream. And when there's more there, on a cellular level, glucose is still sharp, right? It's like, it's like if you take a sugar and you spill it on the table, you look at it, its course and you know, it's sharp, and even on a molecular level, like smaller, smaller, it's still sharp. So when you pack too much of it into your veins and your arteries that run through your heart and your eyes and your legs and your fingertips and everything else that's sharp. This is scratching at the inside of that soft tissue and those veins and those arteries, and one day, it'll wear through a little hole. And if it were through a hole in your heart, you have a heart attack. If it wears through a hole in your eye, you have vision trouble if it starts wearing through in your feet, you might not be able to feel your feet and honestly And again, so all of the diabetes complications that are on a list somewhere in your doctor's office to scare the hell out of you. What it really means is, if your blood sugar is too high, you know, what inside of your body, is it going to rub through first and create a breach? And you know, and will that breach, you know, and that breach will hurt. You might, you know, we talked recently about my friend Mike who passed away, he was on dialysis. So the first thing that it rubbed through worse his kidneys. And then as he was on dialysis, the second thing it rubbed through was his heart. And then he had a heart attack and he died. And that's it. And he'll he'll his death certificate says he died from complications of type one diabetes, though. That's it,

Jennifer Smith, CDE 15:43
right? And that's a great, it's a very layman's way to understand it. Because I think that the textbook explanation is, it's too clinical, it's to medical. And I think that's why, for the most part, people are aware of complications. But when you explain it, such as that damage piece, and I used to explain it in the class, the type two classes that I used to teach is that my sugars, cause damage to the inside of your vessels cause damage to the outsides of the nerves and everything and almost like eat it away. So like a sandblast. Yes, it's like cutting and cutting and cutting and calling causing small abrasions, right, scratches, scrapes, that the body actually tries in your body is a it's a, it's a self healing.

Like organism, right, which

Scott Benner 16:36
is why it doesn't happen to you right away it wrapped fixing little making little patches, it's like your road crew in town filling potholes, when you think you just repave the whole road, they're like, nope, best we can do is pop in a little patch in this hole.

Jennifer Smith, CDE 16:49
And it's more inflammation, I mean, long term, those little holes are really from inflammation in the lining, and along with cells and whatnot. And over time, I mean, if that inflammation causes a tear, the body tries to patch the tear. Well, if more and more tears happen, and more and more patches get placed into the vessels, you know, and I know visually, this isn't a podcast, people can see. But as you can see, my hands get closer and closer together to indicate the constriction and the narrowing of vessels. So then we have heart disease and potential for stroke and problems with blood flow, getting to the kidneys to do what they're supposed to do, and circulation to your fingers and your toes and never anything see. And Jenny, the way I think of it is I was just there one day in my house trying to talk myself into not giving up before I understood what was going on, right? So what do I need to do to not give up and this is how I put it, it's really no different than a football coach who just has a player has three brain cells in his head, and he goes, look, see this line right here. Don't let that ball go past that line. And that really is how I dumped it down for myself. I was like, I can't let that ball go past that line. Like I have to try to figure out how to stop that.

Scott Benner 18:05
And I think everything that everyone's listened to since then, is born from that idea. Like, how do I stop this from happening? Right. And I've had that moment where I realized I may not be stopping it from happening to like, maybe my kid genetically is just the one who can't withstand having type one diabetes. I don't know, you know what I mean, but she certainly has a better chance, the way the way she lives right now than she would if I just listened to, you know, just keep her under 200. You know, don't let her spike over 180 or 160, or whatever, after a meal if you right, you know if you can. To me that was just that just made sense. In the moment when I was scared and alone, and it didn't know what I was doing. I just thought like, I need a I need a I need a goal. You know, right? Why? blood sugar? Oh, sorry. Sorry. Go ahead. No, good blood sugar is gonna say blood sugar is a big piece of it. But you know, the other components to those complications, too, are the other factors that also contribute to blood sugar management, right? So the kind of nutrition you take in that interior sedentary versus more active lifestyle, all of those are also huge benefit for long term health, outside of just rolling or managing your blood sugar. And all of those things become exponentially more important. When you have type one diabetes, they're important to a person who doesn't have it. It becomes even more important when you do like sometimes you just feel like, you know, like how many, how many gunfighters are gonna be on the other side before I just I don't have time to get to the mall, you know, you'd be like, I'm gonna get overwhelmed because there's just so much over there. So you have to give yourself a chance. You know, and aside from the idea that exercise helps you keep lower blood sugars like that aside, exercise does all the other things that exercise you know, it's funny, it's worth mention Hear that I realized the other day that some people refer to me behind my back is like, somebody who pushes carbs on people. And I thought, That's odd. I've never considered that before. Excuse me, but I guess more low carb people kind of can feel that way a little bit. But I listened to it. And I thought it through and I don't feel like I do that. I feel like this podcast teaches, talks about preaches maybe how to use your insulin, like how insulin works. And I say all the time, once you know how your insulin works, I don't care what you you know, you do whatever you want. But I think you need to know whether you're low carb, or whether you're a person who's like, wow, I think I could eat that whole box of hohos. Like, like whether whoever you are in that scenario, you know, one side or the other. If you understand how to use the insulin, you can accomplish it. I'm not saying because I know how to bolster Chinese food. You should do it every day,

Jennifer Smith, CDE 20:54
every day. Every day. I know how to Bolus the chocolate chip muffin and the chocolate milk and the Hershey syrup on top doesn't mean it should comprise every meal. Because is that better than an apple with peanut butter? Right? And nutrition wise? Probably not. But

Scott Benner 21:11
is there a danger I found myself wondering of people focusing on themselves so much as diabetes that they forget to think of themselves as person. Like, you know what I mean, like Does, does a piece of this a big cupcake not seem unhealthy anymore, because you know how to stop a spike from happening when you eat it. And that's important to remember that it's still it's still a cupcake. It's still something that's, you know, a once in a while thing, not an everyday thing, because I can Bolus for it. And I think that's so I think Jenny's point is important too, is that there's just a lot more that impacts your health than just your blood sugar. And we sometimes we talk too much, not too much. But we're so focused on trying to understand it because there's so many components that people don't understand that you stop thinking about like, Hey, you know, what else is easy to Bolus for broccoli.

Jennifer Smith, CDE 22:05
It's learning to manage the insulin around what you eat, you decide what you're going to eat, and you figure out how to manage it, like not encouraging people to eat a high carb diet.

Scott Benner 22:17
Not at all. I don't see it that way at all. I see it as understanding insulin. It's it's just how it is I I was speaking somewhere recently, and I looked down and saw a person in the crowd who this has happened to me about three times since I've been doing public speaking around diabetes. But I've looked down to see what I would call like an old school person in the diabetes community. And when I'm talking I can see on their face, they're just there somewhere between angry and horrified that I that I would even deign to talk about insulin, and how to use it. You know, like, you can't tell people. When I'm on when I'm up on stage, I tell people, no different than, you know what I say here, right? I'm like Basil's first beat, we have to have your bazel, right, because we can't just start Pre-Bolus saying and doing other stuff. Because if your Basal is wrong, it could end up being dangerous. So first, we get your Basal right. Now after that, step two, you have to Pre-Bolus your meals. And that's usually when I look down and see like somewhere like a 60 year old mom whose kids had diabetes for 30 years. Like, you know, like their arms are moving around and like, Oh, you can't say that to people, you're gonna kill them. You know what I'm like. And so I'm like, you're thinking about this in a different way. Before that, you're not considering the technology, you're not considering that these are not the same last lambs that you talked to 30 years ago, right? Like these people are here to find this out. They want to know this.

Jennifer Smith, CDE 23:52
And long ago to bring in long ago, timing was an insulin issue. Long ago, I've had diabetes 31 and a half years, okay, I started on our insulin, and the cloudy, but most people started on something called nphr. And I was on L, which was Lily's brand. Okay. Um, I did no carb counting. I use the exchange diet. I took exactly this amount of searches and fruit portion and vegetable and protein and fat at every meal and my mom or dad gave me my insulin mixed in a syringe at breakfast and at dinnertime and I eat it strategic times in exactly the same amount of food there was no other than measuring the food for the right portion. There was no carb counting, there was no insulin based on carb. It was you take your insulin and from the dosing standpoint, my insulin regular insulin you know, it's slow. I mean, we call it short acting balls forever. I mean, it may man would dose me 45 minutes an hour before I even started to eat in order to curb that post meal,

Scott Benner 25:06
right? Yeah. And so everything you just said, is about using the right amount at the right time. Yeah, it's timing. It's all timing. Like I, again, I that I figured it out. I mean, we should all be able to figure it. Really I know myself, trust me, it's there's not a lot like I'm not, you know, I'm not over here. Figuring out the Pythagorean theory after or a theorem, whatever it's called. I see. I don't know, after I get off the podcast. Yeah, I just don't think i think there's so much fear in now that we forget later. And, you know, what we're talking about right now is long term health. And so let me jump to I can't quote it, I don't have it in front of me. I don't know where it came from. But I think everyone's fairly aware of this article that came out in the last six months that tried to say that lower a one C's aren't necessarily an indicator of health. And that, did you see that one they started talking about, like, you can have an A one see it like this here? It'll be fine. It tried to give the impression to me, that the way I saw it was someone trying to say, Look, I know a lot of you are using this technology to do better, but you really shouldn't do that. Like it's not necessary. And I thought, Well, how do you know? You don't mean like, like, I thought the same thing? I thought when I saw vaping The first time I was like, I have no interest in that. But if I did, I wouldn't do it. Because I don't want to be the one to find out 10 years from now what happens? Because no one knows, you know, right? So is there any in your mind, if you're safely at, if you're in the fives, and you're a one, say and look, you know what I'm going to do here, I'm going to actually pull up an email. To make my point, hold on one second, it's going to take me a second to find it. I apologize for that. But I got this email this morning from a person I know who listens a lot. And when she emailed I thought, wow, this is gonna work right into what Jenny and I are talking about. It's crazy. And it's from Laura. And this note from Laura mimics many, many, many, many notes that I get. Scott, I achieved a 5.4 a one C, first time I've ever been under 6.4. But my doctor freaked out at the number of lows. And she's asking, what's an acceptable amount of time under 70? Like, how many times can I dip under 70? And you know, and so I there's First of all, it's it's a two step thing, right? Everybody who goes to any kind of a doctor who's more like the lady in the crowd, who's thrown her arms around yelling, don't talk about it like this. When they get their blood sugar down, and they find a way to keep it stable, and it starts impacting their variability and it starts impacting their agency, the doctors flip out, they make this assumption that they have all these crazy lows and it's throwing them off. So I know what I'm okay with. But what Where do you stand in your personal life? I guess like how often do you find yourself under 70 DFA.

Jennifer Smith, CDE 28:19
So personal versus professional, I kinda, I really aim for the same thing, quite honestly, overall, and this is where I think that that data is very helpful from a CGM standpoint. Because especially and I speak for clarity. The other reports are the other CGM do give you something similar as far as data. But from a clarity standpoint, clarity always gives you that overview gives you your glucose management indicator, their quote unquote a one see right from CGM, not from your blood glucose, right? It gives you your average glucose, it gives you your standard deviation, and also gives you this little like chart that shows you time in range, right? And it is based on what you have your time in range numbers set for 70 to 180 60 to 140 90 to 200. So you have to adjust those parameters, but clarity has it set 70 to 180, for the most part, right? We aim for the lows specific to be less than 5% of the time. So from all of the gathered data, whether it's two months or two weeks, or one week or whatever you're looking at that percentage of time, we're aiming for less than 5% to the low and low being less than 70

Scott Benner 29:43
less than 70.

Jennifer Smith, CDE 29:44
That's that's the goal is to be low less than 70 or less than 70 less than 5% of the time. So from the standpoint of overall a one see though, you know if if a clinician is coming in saying hey, you know why? That's way too low. And they're looking at data, which proves that, well, gosh, you're hanging out in the 50s. consistently. And that's why you're achieving a five point for sure. And if you're low, let's say 12% of the time, okay, there's some work to do to bring that back up into range. So that that 5.4 is actually better for lack of a better word. better, right? It's, it's more real 5.4 in a target range, that's healthy, safe. And good for you overall. Yeah, you're

Scott Benner 30:33
reaching that number with quality decisions, not with not with, you know, being low. Correct. And that's

Jennifer Smith, CDE 30:40
coming out and saying 5.4% is it Oh, my goodness, that them that's way too low and not even looking at what other stuff 5.4 the person could have very low standard deviation, maybe their variability is 20. And they're ranging somewhere between 70 and like, 120 pretty consistent or 70 and 100. Great, fabulous. You're, you're knocking it out, have at it, and you what you're doing.

Scott Benner 31:09
So when I gave the explanation of a Pre-Bolus this week, this weekend, I used something that had happened an hour before because my wife was at home with Arden and I said actually my wife did a great job this morning with breakfast. About an hour ago Arden's blood sugar was 70 and it was time for lunch. Now Arden's at school, and I think 70 is a great blood sugar right before a meal. Arden's blood sugar was able to stay at that level for a number of reasons. But those reasons are evident to us as they play out, because we can see her blood sugar in real time with the dexcom g six continuous glucose monitor. Not only can ardency her blood sugar right there on her iPhone, but I can see it here at home on my phone as well. Because of that knowledge and seeing the stability that had existed within Arden's blood sugar for the hours prior to lunch, we were able to make a good Pre-Bolus and give her a nice launch into her meal time. Now that hour later, Arden's blood sugar is 132. The data that comes back from the Dexcom g six continuous glucose monitor is life altering with Type One Diabetes, but being able to see it remotely, that takes life altering to another level. So if you'd like to know what your blood sugar is, the speed and direction it's moving, and find those things out without a finger stick. The dexcom g six is something you should check out. I have a link you can use dexcom.com forward slash juice box. There are links also right here in your podcast player notes at Juicebox podcast.com. But I think you should check out the Dexcom Arden's results are hers and yours may vary. But I'm telling you right now Dexcom is a game changer. Now moving from continuous glucose monitoring to insulin pumping. I'd like to talk about the Omni pod until you first I have just as much affinity and love for the Omni pod as I do for next time. Arden has been wearing the Omni pod tubeless insulin pumps and she was four years old, she'll be turning 16 in just a couple of months. The Omni pod brings so much freedom along with the ability to pump your insulin right no injections all day long. No slow acting insulin and fast acting insulin let the army pod take care of your background basal insulin for you. It does that put your insulin pump you get your basal insulin from the pump. And when it's time to Bolus for a meal or to crack the high, same insulin, same pump, no tubing, right so not an infusion site on your body somewhere that's attached to this plastic tubing that runs through your clothing out to a controller that has to clip to your belt. You know whether you're an adult or a little kid, you're not looking to have something clipped to you. Here's what you can do. Go to my on the pod.com Ford slash juice box there, you can ask on the pod to send you an absolutely free, no obligation demo of the new pod. It'll come directly to your house. You can try it on and see what you think for yourself. You can see the difference between wearing a shirt and not having tubing running down your sleeve. Every time I've worn a demo pod. What I thought first was it's amazing how quickly I forget that it's there. This is super important. This is something you have to do every day. You don't want it to be constantly bugging you. Check it out my Omni pod.com forward slash juice box with the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And absolutely free no obligation demo can be in your mailbox before you know it.

Actually, my wife did a great job this morning. With breakfast. She made a Pre-Bolus at like 83 right and it was a big kind of bread First, and Arden drifted down drifted down and she actually hit like 63 for like a split second and came back up. So imagine this 63 probably happened 30 minutes after my wife pushed the button, right? And probably 10 minutes after she had already started eating. So if you want to say she missed, I guess you can, but it's funny. Had she been at 68 everyone would have been like, That's amazing. But 63 is a number that somehow gotten to somebody said, so I'm like, so she hits 63 one revolution of the CGM and right back again, and I said, if she didn't have a CGM, you never even would have known that that happened, right? She's She's wasn't dizzy. Nothing happened like that. I can see it cuz I'm looking at it that this same person in the crowd, this person who's you know, you know, from a property from a different era with diabetes, you know, fell just shy of, you know, back of the hand on the forehead. Oh, Scarlet, what happened? I've got the vapors, you know, I mean, like, that kind of thing. And I was just like, I looked over second, I was like, You got us. I was thinking to myself, like, just stop, like, don't like, look at the rest of these people. These people are in Thrall. They're excited. These are people who a half an hour after they put their insulin in, or running around with their blood sugar's 250. And are you really telling me that that's what you want to say is okay for them. Because when I speak to them privately, when they come up to me, as I'm trying to walk around you guys, we're all delightful. But people would come up and be like, hey, look, this is my, you know, my 23 year old son's CGM, kids like 400 and 300 all the time. Like you tell me, it's not worth trying to do better for this kid. And so I think sometimes, both in the community, in people's minds, in doctors minds, in some older doctors minds, there's just more of that idea. And we talked about all the time, like, it's better not to like, like, I don't want you to have a seizure. Like that's it, like when I say don't die advice, like, that's what they're trying to say that I don't want you to have a seizure. I don't want anyone to have a seizure, either. But I don't want your blood sugar to be 300 all day. You know, it just it's, it's not okay. Because we say these nice things out loud, and other people who are maybe well meaning but don't have good information. They're like, Oh, you know, I want you to be safe, blah, blah, blah. But those people you're talking to online, or whatever your whatever that person's ability to get to people is, you don't get to see those people 20 years later, you don't know what's happening to them. And so I'd rather take a bet on what I'm saying being good for them 20 years later, than what I hear some of those other people saying, I think that if you're going to if you're going to roll the dice one way, you ought to roll the dice and try to be healthy, not hope, hope that your body's the one impenetrable thing that diabetes can't find its way through? Yeah, you know,

Jennifer Smith, CDE 37:47
right. Right. Well, and there's also the safety of bringing those high numbers down to, right. I mean, it's like, you don't want to end up going from an average of 280, which means you're drifting well above 300, and not quite into the low to hundreds to average a to 80, right? Yes, you're not gonna say, Okay, today, we're at, you know, an average of 280. And tomorrow, you're gonna be averaging 100,

Scott Benner 38:11
right, that goes on?

Jennifer Smith, CDE 38:13
Well, that would be a pie in the sky one, it's, it's not actually healthy, drops that fast, drop that fast. I mean, you will have efficient changes in your body. And you know, I remember when I came home from the hospital for two to three weeks after I was released from the hospital. And I think I started with an A one C in the 12, when I was first diagnosed, and my blood sugar was coming down and coming down. My vision changed so much, that my mom had to read me my homework in order for me to answer and she had to write things down. Because my vision was so blurred, I couldn't actually see well enough to read what I needed to get my homework done. Right. So and that was gradually. So again, you can imagine bringing a really high blood sugar down that's been consistently stable high. Yeah, it will be problematic.

Scott Benner 39:11
What I said to this group of people was luck. Like, don't go home, I'll shot out of a cannon, you know, and be like, I usually give a unit for this, but now I'm gonna do five I'm like, No, no, a unit in half, maybe, you know, and I was like, the next time go, ha, that could have been more I said, you know, over days, bring it down over weeks, bring it down, not like don't go home and just be like that. Because that's probably not going to go so well. You know. And, and again, bazel first, and it's funny, no matter how many times I say it, and how many times I preach how important it is. The look on people's faces. When you say to them, I need you to get your basal insulin right is like up then I give up. Like it's quick. It's they're so quick to be like, that's not possible. I can't do that. And I'm like, No, of course she can. And that's why I've got it down to like, they're like, well, how and I was like, Look, there's a great app. pisode on it that you could go listen to them like, but if you're looking for how I think of it, I think of it like volume, like I turn it up until it's too loud, and then I start bringing it back down. So you turn it up a little, not loud enough, turn it up a little not loud enough. And what I mean by that is turn it up a little, my blood sugar is not sitting stable, where I want it to, you know, blah, blah, blah, and then all of a sudden, you get to a spot and you go, alright, that looks like it. Or maybe it's Oh, I went a little too far. I'll turn it back down a little bit. I'm like, but don't you know, one woman's like, by basals? point nine. You know, should but my blood sugar's are 250. Should I try one? And I'm like, I mean, okay, and I'm like, but an hour later when that doesn't work. But could you push it up a little more for me? Like, I was like thinking about what you're saying? You your blood, your bazel is holding you at 250. But, you know, point nine, like, but you want it to come down 150 points, but you only want to move it up. point one. I was like, that doesn't make sense, right? Like, don't you feel like it might need more than that. She's like, yeah, I guess you're right. But that but that's a doctor that scared her not to touch her basal insulin. And so she's, it's just it's, I don't know, I'm a little heartbroken. Like, it's a little it's, it's very exciting and uplifting to talk to people and see them have some ideas they're going to take and at the same time, when they come up to you, and they show you how bad things are. You know, after the fifth, sixth 10th one, you start feeling like oh, gosh, like I'm never gonna reach enough people to make a difference in the world like it starts feeling

Jennifer Smith, CDE 41:28
might even like from the adjustment standpoint, sometimes comes from the people who had diabetes, a long enough time to have actually had a long enough experience with bazel injected insulin, and how long it did a week to really see the difference in an adjustment up and or down in the actual dose and the imprecision in which that basal insulin works on a 24 hour scale. Right. And I noticed immense different, going from lantis to using an insulin pump. Right, an immense difference. It was

Scott Benner 42:10
amazing. Is that where that kind of that that adage is like making adjustments here bazel wait three days and see what happens is that what that's from,

Jennifer Smith, CDE 42:19
for the most part because the well, you know, the basal insulin clears technically within like a 20 to 24 hour time period, right from let's say, for the example of Atlantis is supposed to work 24 hours, most people somewhere between like 20 to 24 hours. And so you adjust, you need kind of at least a 48 hour period, at least after that adjustment of incremental change by let's say two units, to see if that was enough to now hold things level and steady. And then it also depends on where you taking your basal insulin in the morning, or were you taking it in the evening, you know, the evening time was a little bit easier to see. Because you could notice an overnight with only true basal insulin there. No boluses no food, no activity component, you're sleeping on that right? And then through the course of the rest of the next day. How did things look in between meals or after the meal bolus was gone? Did you kind of get into the next meal on a nice stable level? Were you where you want it to be? Were you still too high? Or are you drifting way too low? And then we adjust again, you know, so I that it is probably where that like, adjust wait three days to see if the adjustment held things where you wanted them and then adjust again. It's kind of where that would have started. I like Spock because

Scott Benner 43:39
someone from the crowd asked me, How long is it going to take me to get my bazel? Right. And I was like, well, I said if I think if you listen to that episode, and you really understand it. So maybe a few days, you know, she says how long would it take you? And I was like What time is it now? She goes it's like It's one o'clock. I'm like I could have it done by dinner, you know, like so. And then we would adjust off the the rest of the clock moving forward, like but there's a there's somewhere there's a good number. And it's funny because I just I realized, um, I could just keep looking at the CGM and the side I said, Now, if you didn't have a CGM, it take me a couple days to write, right? Because now we're kind of blind. And we're testing and seeing things and, you know, making sense and seeing if we can see repeating that and stuff like that. It was like but, but looking at it. That's like, That's cheating, almost like that. That's pretty easy. But I also infer things from pitches and lines and and there's no and then people all the time, like can you do an episode about how you see that? I don't even know how to talk about it. Like I wish I did like I just look and I'm like, okay, that's not enough insulin. That's too much. This is here. You know what I mean? Like, it's just, I don't know what pops into my head, but I don't know. I really don't know how to quantify it. If I'm being right. Come on. I'm not joking.

Jennifer Smith, CDE 44:55
Well, you've you've looked at things enough and you understand, you understand insulin. Action, I think better because of the way that you've looked at things and the way that you've taught about things. But sometimes it is hard to just nail it down and explain, hey, if this is happening here, this is why and this is how we would adjust for. And that's kind of, that's kind of what we do. Get people's graphs and information and their insulin here. And like bazel testing for a pump, especially, you know, we'll do a bazel test within a time segment, I get the data The next day, I look at it, adjust here, test again tonight. They do great, that looks awesome, we're perfect. We've got it like checked off, move on to the next. So it shouldn't be like six days in a row that you have to test that to make sure that each single one of them exactly was nailed. Because we adjusted it four days ago, nope. If you adjusted, it looks beautiful with the adjustment. Great, we're moving on. We got it. I've learned

Scott Benner 45:53
from talking to people face to face to that. The stuff they want to tell you that they think is going to help you help them is never the stuff I need to know. Do you know what I mean by that? They start giving me like and it's it's not I don't even mean to be funny about it. Like, they're they've been paying close attention. And they're like, okay, like, here's a piece you absolutely have to understand. I'm like, I don't care about that doesn't matter. You know, like, like, I'm like, how much do they weigh? How old are they? What kind of insulin are you using? What's your basal rate right now? You know, where do you sit steady, when you don't have insulin, you blah, blah, blah. And then from there, I'm just like, okay, turn this up, turn that down, make this this. And then let's wait and see what happens. But it's interesting, because the information they've been given so far has led them to ask almost all the wrong questions. Right? That's the part that I find fascinating, right, is that somebody has been directing them along the way. And now I talked to them. And then I talked to them again, two weeks later. And now they want to make a small adjustment. And they're asking the right questions. It's very interesting. Like, it's just where you, it's who talks to you first. Like it really is, it's like, whoever talks to you first, you win, or you lose, like right then and there. You don't even realize it when it's happening. There's somebody being diagnosed right now, in the world, who's talking to an endo, who understands, and they're going to go on one beautiful path, they'll never find this podcast, because they don't need it. And then there's somebody else being diagnosed right now who's being told all that stuff that we, you know, have to debunk, and then reteach. It's just, it's bizarre. I mean, you don't like, get cancer and get two wildly different ideas like this one, cancer, doctors say to you, hey, listen, we're gonna try a little radiation. And then if that doesn't work, we'll try to cut it out. Is there another doctor that says you should go home, blow up balloons and eat birthday cake, and I'll fix the whole thing? Because it feels like it's that far apart. You know, like, one ideas, right? And one ideas? I mean, I'm sure there's variations in between?

Jennifer Smith, CDE 47:54
Well, I think the extremes truly are the people who still to this day, for whatever reason, will go into their clinical diabetes team, and they get the hand me your pump. It's like handing over like, you know, your foot. I think I said that before. And so it did nothing. And you're like, Hey, thank you. Your pump is like, like your butt. Like, no, not really my foot, just a body part over, they like, take it away from you. You're like, oh, my goodness, you've taken like my body part from me, you know, and then they bring it back to you. If they've dumped this data in, they look at the data. They don't ask you anything. The doctor might actually sit there and actually might push your buttons on your pump. Yeah, physically make all the adjustments for you. And your left, then handed back reconnected with your pump. The doctors like, Oh, we adjusted some of the bezels or we did this and this because I thought I saw this happening here. what's lacking there the education do? You adjust? What were the explanations that person could go home and say, Okay, I understood the doctor adjusted here because he was seeing this. I'm going to Now watch this. I'm gonna see did it help? Does it make it better? Did it make it worse? Do I need to readjust this? How should I readjusted? that's missing chunk. Yeah. And, you know, I think that that ease of not educating people nor even letting them push their own pump buttons to make the changes or add in Hey, b d is in a row this past week. I was at gramma Joe's eating like sloppy joes and birthday cake, and is please don't pay attention to that data. It's not my true trend, but the doctor is basing adjustments off of it.

Scott Benner 49:45
It messing up everything else that may have been working better than that. I brought a poor kid up on stage from the college diabetes network this past weekend. And I just we stood arm's length apart. We put our palms together you know standing side to side I said, you know, I'm going to be insulin, and he's going to be body function and carbs. And I was like right now, he and I are pushing, you know, an equal amount into each other. And we could stand here forever like this. I was like, but as soon as I don't push quite as hard, and he started, like overpowering me, I was like now the carbs and the body function or winning, which means my blood sugar is going up. And it should I push too hard. I start driving that down and your blood sugar gets too low. But as long as we stay balanced, and we're pushing equally on each other, this could go on like this forever. While I'm saying it, audibly I can hear people going, Oh, like out in the audience like, Oh, wow. Okay. And I just as I was saying it, I thought a doctor couldn't think of that. Like, like, you know what I mean? Like, cuz dumb me figured it out. And and, you know, put it into words, like, like, that was it and just them watching that. And it's something I'd done before with my own hands like palm the palm. I've explained, I've gotten people on the phone, and I've made them put their palms together and like, and, like done it. And I just think like, it's, it's just, it was so simple. You could see like nodding going on. And people were like, Oh, Okay, I get it, I found a million ways to talk about it. Since then I talked about like, bringing in more blockers to like, you know, stop by Blitz, like in football, like, I've talked about it a million different ways. And every time you kind of paint a picture around it, you get somebody else to understand it. I just don't know. It just doesn't make sense to me. So these doctors are telling you, I want you to be healthy forever. But then they kind of some of them don't tell you how. And so. So optimizing your glucose, right for long term is going to keep you as healthy as hopefully possible. Right?

Unknown Speaker 51:41
Yes, absolutely.

Scott Benner 51:42
What about gaps of fall off? Right? I don't like the word burnout so much. But what if they just stopped paying attention for a week that turns into a month, it turns into six months, is that if I if I come back from it, now, I'm not trying to give people like, like, I feel like I'm saying, you know, you can go off and, you know, go off and do heroin for six months and come back, and it's not gonna hurt you, right? Like, not me. But I'm saying like, if you have one of those moments that a slip up or your life gets, you know, busy, and all of a sudden you start leaving your blood sugar at 140 instead of 120 or 180, instead of 150. Is there any way to quantify what that means to you long term? Or there isn't really right?

Jennifer Smith, CDE 52:27
It really isn't? Because again, there's nobody has kind of quantified exactly what amount of mismanagement equates to this amount of complication down the road? Yeah, if you don't do this for three years, you will have this amount of heart damage 10 years from now, right? There's no, you can't quantify it. But I think you can also not bank

control that was optimal, yes.

Or the next month and saying, okay, I was really, really awesome for six months. And now I'm going to go on like an eidl convention, blow out in Italy, and just that care or pay attention, detrimental stuff could be happening. I don't know what's happening in your body, but you don't either. It's not great for you. But it's, you know, but you, you're not, you can't bank on the six months previous being like a code over for smoothing that out and being like, Okay, this whole month of like, mismanagement doesn't really count because I was so good before

Scott Benner 53:35
it's like sleep, you could get great rest six days in a row, and then stay up 24 hours, you're still going to be exhausted, you can't run, you can't bank sleep, you can't bank health, you can't like that. That kind of stuff is really super important to understand. But you know, it's funny because at the same time when I'm teaching people how to get going, like with a one season I started trying to impress upon them that overnight is easier than you think you know, and like once your Basil's right, you're not bolusing too much or too little, you're not going to get these wild swings. Now you've got this third of the day, you know, and it's like so if you see a 160 in the middle of the week, in the middle of the day, you can feel a little better about it because you had like, you know, your 85 or eight hours last night, right? It doesn't make whatever impact the 180 spike has. And like you said, I don't know what it does or isn't is or isn't doing your body. But if it is doing something being at all night long, doesn't stop that. But you know, like being safe right now doesn't mean that if I burn my finger five minutes from now it you know, it doesn't make it go away. It's still happening. I think that's really that's good information. So what are we in your own personal life? Is that how you think about it? Like just I'm gonna do my best and hope this works out?

Jennifer Smith, CDE 54:51
I do because like, you know, I

I try really hard not to like I go to all my checkups, right? I mean, I Get like, my heart checked, I make sure that I go to the podiatrist, I make sure that I get my feet checked, I've never had any problems, thank goodness. But I still go for all my checkups. I go on, I see my ophthalmologist to make sure they check all the vessels and you know, do the test for the puff of the air in the eyeball, right? is like

Scott Benner 55:23
an idiot when it hits your

Jennifer Smith, CDE 55:26
anticipation of that puff of a puff of air is worse than the actual puff is. But you know, I do all of those things, because I know that they are a check in the long term. And you know, what, if something does come up, then the checking is also prevention for furthering problem, then maybe you say it, check on something and up now something is happening. Okay? One, I might beat myself up a little bit of I could have done this better, I could have done that. But that doesn't help that's asked, you can't go back and fix it, what you can do is continue to go forward and say, Okay, I can try to do better here. Or maybe I need to add this or now I just need to see the doctor every three months instead of every six months or once a year, or they've got this treatment that could help me and it could make it better. And if I continue to do what I need to do, then I can prevent further complications down the road. So

Scott Benner 56:26
yeah, I also want to say that, I think I've never met anybody so far, I should say, that has told me, I decided I don't care, I'm going to run full force straight ahead, I'm not going to pay that much attention to my diabetes. And however long I make it, it's how long I make it. Whenever one of those people runs into a complication, they have always said the same thing to me, I wish I wouldn't have done this, like you don't mean like, I wish I would have bla bla bla or tried something else. Or it wasn't my fault. Even I didn't know. But I wish I would have kept searching. And and I think that that's the truth like it, whether you make it, you know, till you're 40, when all of a sudden, you're finding out at UT dialysis, or you make it to 70. And you're like I made it to 70. And then all of a sudden you're having a heart attack, a 70 year old type one is having a heart attack doesn't go at least I made it this far, you start thinking oh, I would like to stay alive a little longer. You know, like I get it, I don't think many people get to the point of no return whatever it is, and go, you know, I did my best. And I'm happy with this. I think I think that people such really do feel like that, like, Oh, I wish I would have whatever that means, you know, whatever they wish they would have done. I mean, if you're a person who can make it the whole way and just be like, you know, 35 years old, jumping your car over a canyon and realizing you're not making it the other end to go, Oh, well, I did my best. Like, you guys, like that's a special like, that's a special gear you have. But what I'm saying is that caring now will keep you from that feeling of I don't know what that feeling would be what how to describe it. When people talk about their they are disappointed in themselves. And then they can't shake that feeling for the rest of their life. Right? Like every day, they wake up with a problem. And they have this feeling like, oh, maybe I could have done something about this. And then you have to live with the problem and the guilt. And it's hard, you know, so I say all the time. I think with what we talked about on the podcast, diabetes becomes pretty. You know, I don't like to say easy, but I think it becomes like second nature thing for you. I would rather put that effort into understanding Pre-Bolus or, you know, something like that, then I would spending six, eight hours a day fighting with high blood sugars that cause a low that have me eating, that make my life feel like turmoil that I'm not living, I'm just existing through rock. So that's how I feel

Jennifer Smith, CDE 58:56
having and that I agree. And it's kind of the way that I feel about my own management is I do the things that I do every day to make it less of a visible upfront in my face, to let it be more of a Yes, I have to manage it. I still have to look at my blood sugar, I still have to take my insulin, I still have to count my carbs and Bolus the right way and whatnot. But those are like more second nature things that I just do now. And until I have like a bad site or something that I really have to completely put my focus into and you know, take care of

Scott Benner 59:37
the normal things that I do every day are just part of my day. Exactly. And those bad sight moments, because I recognize what you're saying is how Arden's life is and mine with helping are is that most of the time we are just sort of cruising along. And when something really goes funky, and you're all the sudden you have to stop thinking about life and you're now you're focused on this diabetes thing in my heart. I know that some People live like that all day long every day. Right? And that's just because that's an explanation to me like your bad sites a great explanation because you're but all that means is you're not getting insulin the way you need to. Mm hmm. And if if your bagels off if you're not Pre-Bolus if you're not doing all those things in every moment, you're not getting insulin the way you should. And, and so your life's always gonna be, you know, I like that.

Jennifer Smith, CDE 1:00:22
And in the instance, then of

blood sugar's being all over, you never really know unless the pump tells you if you are on a pump, that you have an occlusion and that there is a real problem. You never really know. If there's a problem you should be addressing. Yeah, I mean, I know when I know even ahead of clusion alert coming, that something's not right. Yeah, I can tell. Yep. Um, because things are contained. And if I see something odd happening, and I know that nobody is like, injected me with like the sugar to

Scott Benner 1:01:03
go,

Jennifer Smith, CDE 1:01:04
right, then clearly, I'm not getting in. For

Scott Benner 1:01:08
whatever reason, I don't know, change it out. I don't care what I'm going to address it, I'm going to take care of it. I'll just change my pot out and move on. Let's see you and Arden have a scenario, a life where your expectation is a lower, more stable number that reacts the way you expect it to. We said this the other day, when we were talking like I, I talked about how I think of the site as doing what I expect it to do. So the minute I don't see it, doing what I expect, or I see a blood sugar, that's all the sudden 150 my my I start thinking like, I can look back if I didn't mess this up somewhere. This is this is I'm not getting enough insulin. So I don't mess with that either. Like there's a moment. Like I think some people end up looking at a bad site for days. And then and then they they'll change their property. Oh, it turned out to be the pump 48 hours later. Right? Yeah, I'm not into that. You know what, the second or third time I bolus and what I want to happen doesn't happen. And I'm getting out of it. Yeah, I actually had

Jennifer Smith, CDE 1:02:08
it this morning. I mean, I wasn't, I wasn't actually supposed to change. My pod out until this evening is when it was supposed to expire. And I woke up this morning. Not at my normal like, he ish blood sugar. I was like 130 something I was like, kind of odd, right? And like, that's not where I should be. And I could see all this, like, positive temping that been kind of happening. And so I look at my site. And it's bloody in the window, or my pod site, right? And I'm like, had I not checked, I just gone I've got about three, though I'm higher than I normally am this morning. And I'll just correct some insulin, I'll eat for my or I'll take for my breakfast. And hope all goes well. Well, I just I know that that's not the norm for me. So what did I do? I changed out my pod. And that's it.

Scott Benner 1:02:58
Yeah. Because you're you would have been fighting with that all day.

Jennifer Smith, CDE 1:03:01
Otherwise, right? Oh, correct. In my post breakfast would have been for it. I'm sure. I'm sure. I bet she gets

Scott Benner 1:03:06
to 20. That in that situation? Right. Right.

Jennifer Smith, CDE 1:03:09
Yeah. Right. At least. Exactly.

Scott Benner 1:03:12
So, Jenny, if you and I were one person, we'd be a super diabetes brain.

Jennifer Smith, CDE 1:03:17
Oh, my goodness.

Scott Benner 1:03:22
place? Oh, my gosh, all right. I know you got to get going. I'm not sure if we talked about what we said we were going to talk about, but I found this to be a really great conversation about, about long term health and, and ideas of how to get to it and why it's important. So thank you very much.

Jennifer Smith, CDE 1:03:37
Yeah, absolutely. It was, it was good. I think sometimes, you know, the stuff about complications and whatnot gets, it gets to clinical. And I think people just need a return to all that. That's why I'm aiming for just keeping things tighter, or why I'm keeping things more in this range, or whatever. I mean, they know that the complications are out there. But this is the reason I'm doing that

Scott Benner 1:04:04
instead of talking about a thing that seems like it's so far away or so impossible, that there's no real reason to try to plan for it not to happen. Because it's so far I will always use this example. My father smoked cigarettes all day long, two and three packs of cigarettes a day and not like not some like Marlboro light thing like Chesterfield kings, no filter, you know what I mean? Like it was left over on the floor of the place that they just roll up and sold the people you know, and in his 30s in his 40s, in his 50s, smoke, smoke, smoke, smoke so 60s, he'd come back from doctor's appointments doctor says, I can't even tell you're a smoker and he would wear that with a badge of honor right up until smoking killed him. right up until he had COPD, and then and then he died. So you know, can only you can only you You only stay ahead of a charging bowl for so long right and right you don't want to be you just you don't want to give yourself

Jennifer Smith, CDE 1:05:07
up off the path and be like, let it run by. run by.

Scott Benner 1:05:12
My dogs are barking like crazy. I think someone's breaking into the house. I might be killed soon we'll find out. For me, Kelly, probably Yeah. Oh my god finally dating. Oh, I hope not. All right, I will talk to you soon.

Jennifer Smith, CDE 1:05:29
Okay, awesome. Bye. Bye.

Scott Benner 1:05:33
I bet you didn't know that you can hire Jenny. She works at integrated diabetes, just go to integrated diabetes comm or there's a link right there in your show notes that you can email Jenny directly. Jenny is not a sponsor of the show. She's a friend of the show. But that doesn't change the fact that she's got a mortgage to pay. huge thank you to Dexcom and Omni pod for sponsoring this and so many other episodes of the Juicebox Podcast, my Omni pod.com forward slash juice box go there today. Get the demo pod get a pod experience kit sent to you and get your Dexcom g six continuous glucose monitor right now stop waiting dexcom.com forward slash juice box. This episode is the 17th of the diabetes pro tip series. It began back on February 25 2019. With an episode called newly diagnosed you're starting over and there was 211 to 12. That's all about MDI and all about insulin to 17 to 18 and to 19 Pre-Bolus in Temp Basal and insulin pumping to 24 to 25 and 26. mastering a CGM bumping and nudging and the perfect Bolus, Episode 231 about the variables that come with Type One Diabetes, Episode 237 setting basal insulin 256 exercise in Episode 263. We talked about how fat and protein impact your blood sugar's and they do. Episode 287 illness, injury and having a surgery with type one diabetes in Episode 301, glucagon and low blood sugar emergencies and Episode 307 emergency room protocols different than illness injury and surgery. This is what happens when you're thrust into an emergency room. Not something you were planning for. And of course today's episode 311 diabetes pro tip long term health. Thank you so much for listening to the podcast. Please leave a rating and review in Apple podcasts if you're enjoying the show. But moreover, if you like what you've heard, find someone else who could use it the only way a podcast grows by word of mouth. So I appreciate it when you tell somebody else about the show.