#612 Diabetes Pro Tip: Female Hormones

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 612 of the Juicebox Podcast. This is also the next episode, the diabetes Pro Tip series.

On this episode of The Juicebox Podcast, Jenny Smith and I are going to be talking extensively about hormones, female hormones, about getting your period about riding the won't say that about shark week. You know that time of the month where your baby box is trying to kill you. And we're not going to just talk about your period, but we're going to talk about the lead up. And afterwards, the entire month really, and what you can expect as your hormones fluctuate and change. Please remember that nothing new here on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Right now I'm considering putting a ton of euphemisms for a period at the end of this episode. Not sure if I will or not. It's all kind of up in the air. Hey, if you'd like to help out the podcast, head over to t one D exchange.org. Forward slash juicebox. If you're a US resident who has type one, or is the caregiver of someone with type one, I'd love it if you'd fill out their survey. It'll help people with type one diabetes, and it supports the podcast. This episode of The Juicebox Podcast does not have a sponsor. Not that I don't have a sponsor I could put on the podcast that I certainly have. But I just wanted to take this opportunity to remind you about the other diabetes pro tip episodes and some of the other series within the podcast. Can I do that? Will you give me a second? Thank you. At this point, the diabetes Pro Tip series consists of 25 episodes. This one of course, is female hormones. But there's also honeymooning weight loss postpartum, glycemic index and load. Explaining type one diabetes, pregnancy bumping nudge one bump and nudge to long term health emergency room protocols glucagon and low Beegees. Illness injury and surgery fat and protein exercise setting your Basal insulin variables the perfect Bolus, mastering a CGM insulin pumping Temp Basal Pre-Bolus, all about insulin, all about MDI newly diagnosed starting over actually listed them in reverse there for you. But you can find them right now at diabetes pro tip.com. There are 1,000,000% free, they're not paywalled. You can get to them and start them and stop them or listen to them as you would like. I'm going to tell you that I think if you listen through those pro tips, they're a pathway to an A one C stably in the low sixes or even fives. Everything I know about type one diabetes management to be important is in those episodes. And along the way, I always have Jenny Smith, there with me having those conversations, I'm going to tell you at the end of the episode all about Jenny, but for now just know, she's had type one diabetes for a very long time. She's a CDE. And a lot more. So head on over to Juicebox Podcast comm or diabetes pro tip.com. Or you can just go back in your podcast player to Episode 210 and start right there. I really hope you do. There's a ton of information in these episodes. I think they're very easy to listen to and even easier to understand. I hope you take advantage of them. All right. Okay, give me a testing. Hello. Alright, you're there. I'm there. Okay. Yeah. All right. So I've spent, not my whole life, you know, but the last number of days and weeks looking into all of this, trying to get ready to make a pro tip episode about female hormones. And it's a very scary proposition. There's a lot going on. I'm not scared, scared, but I'm overwhelmed. And then the last kind of piece of it was that I went on to the Facebook page and you know, said to people look, you know, throw out your questions for this episode. I want to be clear, I almost didn't think I needed their questions so that we could talk. I wanted to see if there was repetitive need, like, what are people like same questions over and over. And my goodness, I mean, it's kind of obvious, right, like so. The questions ranged from like, just God, is there any rhyme or reason to this to what about menopause? What about Hurry menopause. What about the time where my kid isn't getting their period yet, but it's starting to exhibit, you know, symptoms and having hormone fluctuations, talking about puberty and then pregnancy and then and then

is your head spinning post pregnancy? It's it's listen nature. God, I don't care what you think this is there's got to be a better way to do this. Someone, someone, this was an afterthought, like like someone at the end was like, oh, you know, here's what we'll do, we'll throw some eggs in here and then you'll have to throw in some estrogen to get the eggs really roll and then one egg will come out. And if they don't get pregnant, the whole thing will just bleed out of their vagina. Perfect. Like, I don't know who what. Oh, my goodness, PCOS keeps coming up. Is that polycystic ovarian syndrome? PCOS? Yes. Now I know those words. So already, Jenny, I want you to tell me what you just said before we started recording about the inequities of diabetes management from men to men to women,

Jennifer Smith, CDE 6:11
or from an education standpoint to begin with. I mean, it was not something that was ever discussed in my presence, at least and I don't think my mom had outside of visit conversations with my peds and know at all about hormones. Right. So I learned all of this as I was having this like, typical cycle, you know, that should happen after a certain point in the sort of teen years. And education today. It focuses on diabetes, in general, right? Not on if you're a woman with diabetes, versus if you're a man with diabetes, these are the differences that you will definitely see. So you're a woman with diabetes, you've got all the female hormones pumping in your body. Let's discuss diabetes from the angle of being a woman. Right? I mean, especially for my like, I would even say, when I start working with somebody, if they're from about the age 1011, all the way into wellness, even the women they work with into the perimenopause and menopause age, that's something in an initial visit, I always ask about, because if even if it isn't yet visible, it will be at some point. And people need an idea that they need to like, see out into, if I see this and this and this, I'm clearly not a crazy person. This is body function.

Scott Benner 7:44
Well, I guess especially given that, you know, because we talk about things in general terms, like the cycles, 28 days, that's in general, it's not, it's not for everybody, and it might not be for you from month to month as well. So if you can imagine when you hear people talk about like diabetes, like just when I thought I had it, it changed or you know, those memes, there's meat is it memes? Oh, my God, I'm old, you know, where it's like Monday, two plus two is for Tuesday, two plus two is seven, you know, Wednesday, two plus two was zebra like that kind of stuff. If that's already how diabetes feels to people in general, and then you put this on top. I mean, you really are kind of creating two different spinning layers of confusion that can impact each other, or show up on their own. And I don't know how you're supposed to make sense that I actually after going through all this, I have an idea I'll share at the end about how to get a handle on this. But I just don't know. Well, I guess to give people some context, Arden 17. So this is the depth of my understanding of this. My understanding of this is I'm married, I've lived with a lady for a couple of decades, and, and my daughter has diabetes, and she's been getting her period for a while.

Jennifer Smith, CDE 9:06
And I bet you never paid as much attention as when it really was in reference to diabetes management.

Scott Benner 9:12
Only thing I used to pay attention to was there's this what I call the nice day, there's like this. There's this. There's this literally one day a month, where my wife is a 1950s. Like, I'm making quotes perfect mom wife, Glover. Like it's that day on that day. I feel taller, more handsome. Like, you know, like she is so incredibly

Jennifer Smith, CDE 9:41
kind of like Leave It to Beaver mom, sort of at that age have an idea of what a Mom was right? Yeah.

Scott Benner 9:46
100% and I and I, I bask in that day because the day that comes after it. I can't even look her in the eye. Because if I do something wrong, she's the different like and then I Know that the the event is coming in about five to seven days. Like that's how it works for us paid enough

Unknown Speaker 10:07
attention to actually like I can tell you many, many spouses or partners.

Scott Benner 10:13
I thought I was gonna die. I was defending my own life, you know. And so for years, that's the only way I've ever thought about it. And then Arden starts to get her, you know, and then we're kind of rocking along taking care of Arden's blood sugar. Like, it ain't nothing some days, you know, it's just like, I do really have this all figured out. And then one day, she started getting her period. And it was all fine at first. It actually almost it got more difficult at some junctures. But it was, it was very structured. So I didn't have any trouble with it really. Right. And then all the sudden her periods got heavy. And you know, people listening will know that, you know, Arden went through a year or two of like us not understanding what was going on. She got anemic a number of times, she had to have iron infusions. This was all ended up being because of her period. Right? Yeah. So Arden would get her period for like, 11 days, like she'd have like a 11 day long cycle, and then only a couple of day break before she started to bleed again. It was just ridiculous. Which led us to put her on birth control, hoping, like, you know that she wouldn't bleed to death. Because she was, I mean, the impact on our life was insane. Sure, you know, and so first go round with the birth control they gave her it wasn't strong enough, didn't really do anything. But they still ask you to be on it for 90 days before they consider changing it. So you, you struggled all this time you think you have an answer, and then 90 more days struggling. And then they moved her up to another, I guess strength and that has, you know, straightened out her. Excuse me also, the first indication of that problem was nosebleeds. Oh, really bad out of nowhere. nosebleeds, right? That only happened once a month. And it took us a while to figure it out. It was literally happening on a cycle. I never was able to connect it to her periods. But the minute she went on the birth control and the second round of birth control, and it straightened out her periods. The nosebleeds never happened again.

Jennifer Smith, CDE 12:34
That's really interesting. Well, and I mean, again, a symptom that if you're paying enough attention to your body, there are lots of things that your body is trying to tell you. Yeah, right, if we just pay attention to.

Scott Benner 12:47
And it's why I bring it up, honestly, because part of what I figured out, Jenny, part of what I figured out being a man who doesn't get a period, and a person who doesn't have diabetes, as I considered talking about this with you today was was that you kind of have to, you got to kind of have to Jane Goodall it a little bit, right, like you got to take notes and step back and see things and keep wondering what's happening until you can build some some idea of like, I keep seeing this thing over and over again. And where does that fit on the calendar? And how does it work in relationship to, you know, bleeding or pain or insulin resistance, and then sort of start making sense of it, you have to track your period, maybe for six months before you'll be able to wrap your head around it a little bit,

Jennifer Smith, CDE 13:37
especially if your cycle is not regular. I would say for women who especially women who are considering maybe you're starting to track things and pay attention because you are planning a pregnancy, or maybe you're really trying to prevent a pregnancy. So then tracking things becomes just as important, right. But then along with the lines of even planning a pregnancy, the goal in diabetes is to have pretty optimized management prior to conception. So yes, I mean, you really should be tracking things for a fair amount of time, if you don't have them already nailed down because you've paid attention, right. And there are a number of really good period apps out there. I mean, there's some that are free that do just as well as some of the ones that have all the 1000s of bells and whistles for tracking everything else. But I think the ones that are the best actually have a place where you can keep notes. Because the tracking app that I like to use, I actually track month to month, how my insulin changes have looked this month. So I can go back last month, the month before and actually see, has it been consistent enough? Is it going along with what is normal for me? And that helps.

Scott Benner 14:52
Well, even very recently, in the last couple of months, Apple added a period tracker to their health app, which So interesting, robust, and it's free, and a lot of people use Apple phone. So I wanted to throw that out there.

Jennifer Smith, CDE 15:06
I didn't even know that was an option. So thanks. Yeah. So

Scott Benner 15:09
because Arden uses one that's third party, I don't even know what it's called now. But as I looked at people's questions, and I thought about Hold on a second. The gods are coming after me for talking about periods when I'm not a lady. That's right. As I thought about how I figured, like, like, step back and look at what we had to go through to try to figure this out for Arden. And then I looked at people's questions. The real fear, when you see fear is around the unknown portion of it. And all I could think over and over again, when I saw their questions like, How do I know if it's gonna fluctuate? When do I turn up my Basal insulin, if I can't be sure when it's gonna start? I kept thinking, you're gonna have to track it, you're going to have to pay attention, you're going to have to put like, work in. And I know, that sucks, because it feels like diabetes has already worked. But it really made me think about like, kind of what we talked about another pro tips, which is, you know, some upfront effort can save a lot of heartache, right, over and over again,

Jennifer Smith, CDE 16:13
or a lot more micromanagement than you really should need to be doing?

Scott Benner 16:17
Yeah, yeah, you get stuck in that situation where you're constantly constantly constantly adjusting your blood sugar. In the moment, which I'm, listen, I'm a fan of if you're lost, to stay flexible. But in this situation, where what was the number I saw the average woman's going to have how many periods like 400, and something or I was like, oh, like,

Jennifer Smith, CDE 16:40
hold on a lifetime? Well, I guess if you expect an average age of a period starting at the age of 12. And there are 12 months in a year, right? So you would have, let's say one cycle a year. And then the average time period of a cycle, completing would be about, let's say, age 12, all the way to maybe 55, let's say maybe even 60. And that's a good amount of time that you would be having cycle.

Scott Benner 17:15
I'm using your math 55 minus 12, is 43 times 12 months, is 516. There you go. So I'm saying

Unknown Speaker 17:24
that's a lot of tracking.

Scott Benner 17:28
I'm saying put in put some like real, like, it's gonna be honest effort, because you're gonna have to track you know, your insulin use every day. And, you know, just giving yourself I think, what helped me was just simple words. Difficult, easy. You know what I mean? Like, referring to my management, you know, meals were, what I expected, easier than I expected, harder than I expected. Yes. You know, my Basal seemed to work. Well, not Well, today, like just kind of keep it keep it like that. You make a little note for yourself. And I'll tell you to tracking your period is going to help you get better at taking care of your blood sugar, too, because you're gonna see all kinds all around. Yeah, yes, yeah, all kinds of things that you didn't, didn't see before. To begin with. You're

Jennifer Smith, CDE 18:13
gonna learn a lot of things too, in that time tracking for all of those other variables that we have to adjust around, right? Because I for one, know that my sensitivity, once I've gotten to about day three of my period, after that point, and until about ovulation is a really sensitive time. But it's more sensitive from day three to about like day seven ish. And in exercise, I have to be more aggressive and adjusting my insulin for exercise. Or I will go low. Despite my other tools and tweaks working outside of that. I will go low if I don't adjust more than I normally would, is that

Scott Benner 19:02
a progesterone period in there.

Jennifer Smith, CDE 19:05
So you're essentially when you're looking at progesterone that is typically like peaking at certain points, right? And then there's also the luteinizing hormone, there's follicle stimulating hormone and there's estrogen and a lot of hormones that are coming into play. So progesterone kind of starts to really kind of like, fall off essentially, once your period is started. It has really climbed in the time of you coming into potentially having a period and part of the reason for that is in the anticipation that you in sort of that Avi LaTorre time period, have actually conceived right. progesterone levels will stay high and continue to climb in pregnant See, when you don't have conception happen, and you start to have your period, that level falls, because there's no reason to have that elevated. I mean, again, other hormones at play here as well progesterone being one of them, but it doesn't need to remain where it was because you're not pregnant. Okay. And so then it fluxes

Scott Benner 20:21
right. And do do we let's try to think about this. Do we count the the beginning of the cycle is considered when the period starts, right?

Jennifer Smith, CDE 20:32
Day one of your period is day one of your cycle.

Scott Benner 20:36
Okay. In that moment, estrogen at that point is lower. Is that right? And then it starts to,

Jennifer Smith, CDE 20:45
and then estrogen starts decline coming into ovulation. And then in that next phase around ovulation and potential like conception, again, progesterone is sort of like climbing into that time period. Right? So, you know, again, all these fun hormones doing different things. I mean, if you even looked up a simple like just Google, a graph of like, what your hormones should look like, you can tell why. One Basal for 30 days in a row, if you're a woman who has a monthly cycle, doesn't work. Yeah.

Unknown Speaker 21:27
It doesn't,

Scott Benner 21:28
you know, what else I learned by digging into all this is that not that I wouldn't expect this because it's a physiological thing. But it's incredibly complicated what's happening. It's not just like, you know, your your eighth grade health understanding of it, which, you know, in my mind was, an egg gets released, you use it or you don't use it, if you don't use it, you know, the uterine lining and the egg come out in a period, which I know is high level what it is. But the idea of like the ramp up, right, like the gosh, like you start talking about like follicles, and like, there's this process that's happening in there, where your body's trying to locate the strongest egg to be released. It's not just like the next one on the assembly line. It's like it literally anyway, it's mind boggling. Even the TED talks on it are confusing. Even when even when nice girls sit in front of cameras in front of YouTube and try to talk to you right in your eyes, you're like, I don't understand, there's so much happening. But I think for the case of but for type one for using insulin, is it is it as easy as saying that there's a time when you're bleeding, there's a time when you're ovulating. And there's a time when your body is trying to make your body a hospitable place for sperm to live. So that the process of fertilization can happen well, is that basically like there's I mean,

Jennifer Smith, CDE 22:52
that's basically the simplified and I think, sort of along the same line of what you're getting at is, if you, if you're having a cycle, whether you're on birth control with a cycle or you're not on birth control with a cycle, you can expect the times of your period to show similarities for you in insulin need, right? One person may experience during this phase of, you know, hormone release, or this phase of their cycle, that they always have higher blood sugar's now that they've been tracking things, they can say yes, I'm always getting higher here. One of the first places that that commonly starts is the fasting blood sugar, or the overnight blood sugar. For whatever reason, in the hormone dance of the human body, that's the first place that commonly women see things are running higher. And if you start to pay attention to your calendar, it will most likely coincide with that's going to be somewhere about like, three to maybe seven days prior to your period, starting. Some women experience really short lived higher insulin needs. And whether they may have missed a slight nudge up maybe a week sooner. Most of them notice, gosh, the first you know, day and maybe the two days before my period, I'm just high I can't take enough insulin, I dump it all in and I still sit high. Well, next month, you know, if that's the case, and you start seeing higher blood sugars, and you do and you are maybe somebody who doesn't have a regular enough cycle would probably expect that this is what's probably on its way as long as your site isn't bad and you know, all the other variables that it could possibly be

Scott Benner 24:42
Yeah, so it's going to be incredibly important for you not to throw your hands up to the diabetes ferry and go it's just did diabetes. It's happening to me again, like after it happens a couple of times. You gotta say like Jenny saying, like, this is what happens. Whether or not I can tell you that it absolutely happens on day. I don't know 30 Have my cycle or not? It becomes unimportant like you, you sort of see, you know, it's not any different than like, as you're talking about all this and about when people see higher blood sugars, like Arden has this too, but because my mindset is, like more insulin push back, don't let it happen. I can't see it. Sometimes I can tell you that we're bolusing more or that I'm running a higher Basal like profile. But I'm so accustomed to just being in the fight and fighting the fight. I sometimes don't think about why it's happening. I just, I just adjust

Jennifer Smith, CDE 25:35
to get it back to target. Yeah. And I and I think that's, that's okay, as long as you're okay, adjusting that way. And if that works for you, then great. I think that more women especially again, those who are planning a potential pregnancy, are really wanting to track well enough because they're also in ensuring that their blood sugar's are really optimally managed for possible conception and that thereafter, you know, so if you really do want more consistency, rather than saying, Well, I know how to do more insulin, I do it all the time. I just, you know, adjusted here and take more, they're adjusted back here or whatever. But if you have even those that have irregular enough cycle, it could take some of the like headache out of the arm Hi again. I know I need more, I'll take more. But gosh, is this happening regularly enough that I could actually figure out how much more do I need on an average monthly change time? That is less guesswork in the moment that

Scott Benner 26:38
and the reason I brought it up is because the process of getting ready to make this episode with you made me realize I'm gonna set up three different profiles for Arden because she's gonna go to college. Yeah, know what to do her blood sugar's gonna go up and she's gonna be like, this never used to happen before. You know, and and she's, you know, not gonna realize the thing she's missing is me. Texting, texting or going yo Bolus, what are you doing? Cuz because for people who don't like really understand, I know it sounds like micromanaging to some like newer people but for people listening the podcast I don't imagine it does. Like, I don't like to see a blood sugar over 140. And I act like like, you know how some people might act when your blood sugar's 300 is about how I start feeling at 140. I'm like, yo, what are we doing here? Because in my mind, I'm targeting back to 80 in my mind, 140 60 points too high. Like, get it get it, but the the amount of insulin that it takes to get it has climbed since Arden's been on a birth control pill. So while yes, the birth control pill has regulated Arden's period, and she's not bleeding to death anymore, her diabetes has gotten more difficult. Yeah. Because and now if you go look at graphs about how insulin like listen, what I know about birth control is probably not enough. But you're getting you're getting a pretty regulated amount of these hormones every day. And and that birth control is literally tricking your body into not releasing an egg. I didn't realize that. That the bleeding

Jennifer Smith, CDE 28:16
keeping you on a one cycle of hormone akin to not needing ovulation.

Scott Benner 28:22
Yeah, right. And so you're not nothing's happening and ovulate. Like the whole process isn't happening. Actually. I think what confuses people? Is that the bleeding that happens when you're off the hormones and you're on the the placebo? CBOs is not your period. It's got it's actually got a name. It's, uh, hold on a second. I have so many browser windows open. It's called withdrawal bleeding. Yeah, yeah. It's not your it's not the same thing

Jennifer Smith, CDE 28:51
I never heard. I've never heard it called that before. Okay. Well,

Scott Benner 28:55
I was schooled, I recorded an episode about this with a different podcast. I'm gonna be on a vagina podcast pretty soon. And that's funny. Oh, it was hilarious. And as I was being asked, I was like, why is this happening to me, but um, but people who really take birth control? I don't mean seriously is the wrong word. But but see it as stuff that maybe, you know, there are people who think you shouldn't do it. There are people who think you shouldn't tell people how to live their lives. There's a lot of consternation around birth control in some circles. And it's important for those people for you to know you're not actually getting your period when you're on birth control. So and I have to be honest, I don't want Arden to be on birth control not because it's birth control, but because I don't want her to take anything she doesn't have to take right but she's she was going down. You don't I mean, like Yeah, we were looking at a real like, I guess this is it. Like you know the money with the money we save for college. We could buy a house with now or something Well, and

Jennifer Smith, CDE 29:56
that's I mean, those there are I think really there really good reasons to utilize birth control all around, there are. But in a case like this, it's almost a necessity in order to get containment of something. Now, the other thing is, you know, is this something that's just, it's just the way that her body is going to continue to work even into like adulthood, where she continued to have to have this level of birth control, you know, management, so that she doesn't have this problem. That question, you know, I

Scott Benner 30:29
had constantly like, when do we just like, stop at once and see what happens? You know what I mean? Like, right, but I don't understand any cause and effect reasons why using birth control for a while, would you know, quote, unquote, regulate things? And then you would need it anymore? Were? Or was this just a cycle of her life, and it was going to pass on its own. And we're never going to know, as long as she's on the birth control pill, right. I keep praying, I keep thinking maybe, you know, a few months before college, maybe we like, would try Bella bail on at one time and see what happens, because you've

Jennifer Smith, CDE 31:06
done enough work already to know. I mean, she's used several different types of it. So you also have an idea of what works, what really did nothing good. And what does actually work because there are so many kinds of birth control that are available, and so many mixes of hormones that you could use, or some are single, single hormone and some are a mix of hormones at different levels. They're taken different ways. I mean, there are

Scott Benner 31:39
one point are our pharmacy benefits changed or over to a generic things were going great. And then they change the generic a went right back to where it was again. Oh, and then we had to swap her back to another one.

Jennifer Smith, CDE 31:53
So funny, right? I mean, if it was the same thing, only a generic what's different, right?

Scott Benner 32:00
I have no idea. This is the this. Jenny in one way or another vaginas are the bane of my existence. Just there. They're torturing me from different angles and different perspectives all the time. And, and on Arden's period has been, I mean, a roller coaster, it has not been fun for her for the, you know, people trying to help her.

Jennifer Smith, CDE 32:24
Well, and I think you see it from a perspective of, you want the best for her, you want her to be healthy and enjoy life and everything. So you see it really as a it's problematic, not from a physiologic standpoint is problematic and what it brings into the picture of her management, you know, you may have a very different look on it. If she didn't have diabetes.

Scott Benner 32:50
Yeah. Yeah, I guess I there's so much about I wouldn't even understand or pay attention to her. Right, sir. So I, I'm basically having this conversation to tell people that I'm going to start doing what I think you should do, like I'm gonna, I'm gonna set up my own tracking app. And I'm gonna track Arden's like insulin inputs, just Jenny's making a face because I don't do

Unknown Speaker 33:13
I'm pretty yummy. Yes. Like, you don't do things like that, because I don't

Scott Benner 33:17
She's gonna leave for college and either bleed to death, or have a one see in the aids like one of the other. Like, it's just one of the others gonna happen. So And typically, I

Jennifer Smith, CDE 33:27
mean, that is, it's also another piece in the mix, too, because you brought a lot of things in that could be happening in periods that are mismanaged, right? Someone who has excessive bleeding can bring in a lot of other health risk problems that can also make the diabetes management piece even harder to figure out and manage around. So it's really important. I mean, on average, you know, quote me, but I think I read at one point, like the average woman with a normal healthy cycle length, and not excessive bleeding, really only loses about a quarter cup of blood through the whole period, which is it's a tiny amount, right? I mean, if you know what a quarter cup measuring cup looks like. So I mean, if you're saying gosh, excessive, clearly excessive is like, lots and lots that shouldn't be happening.

Scott Benner 34:22
Here's the one measuring stick for you. Arden's ferritin gets down to like the teens. She gets an infusion. They tested again, it pushes it into like the 130s. It gets pretty high when you get the infusion. Yeah, within three months of not being on the period. She was back in the teens again, teens again, yeah. So and just I mean, for people who don't know an email, low blood, low iron, whatever, you know, however you get to it. I mean, just can't hardly pick your head up. Oh, freezing feels horrible. You feel like you're dying, the whole time, shortness of breath. You can have heart palpitations. Like it's not good, you know, you get pain in your, like muscles and joints and like it's it's terrible. So Arden's gonna stay on this as long as she needs to but, but it's funny while she was home, Arden's chill at home, like when she was going to school from home, she needed less insulin. As soon as she went back to in person I knew her needs, were going to go up again. And I did the thing, where I was bolusing too much and didn't adjust settings for a little while to like, it happens to everybody, it's sure doesn't not happen to me, because it's my podcast, like, you know, like, you're so used to managing one way, and then this big piece of your life changes. And you don't even realize it for some reason. And that just made me sadder when I realized that thinking about this, because basically, on your period, your life is changing. Like every couple of weeks, you know, like there's this impact and the end, it might not happen to everybody, there are some women who will listen to this to go, oh, that doesn't happen to me. Or if this is, you know, just like, Oh, my God, well, in

Jennifer Smith, CDE 36:07
fact, I've got, you know, some women that I've worked with, you know, even outside of like preconception planning, just in terms of diabetes management. And obviously, the cycle is a piece that we talk through and talk about, and some women who actually have the higher blood sugar levels during their period. Not before. It's more really an onset while they're actually having their period, which is not the typical of what I've seen. But again, I've heard it enough that it's also not odd or rare.

Scott Benner 36:38
Yeah, no, no, in the questions that I sent to you that that I found online, it was almost like people were like, hey, during these days here, my blood sugar is incredibly easy. And then somebody would come along and say, well, in those same exact days, my blood sugar's incredibly difficult. And yeah, I'm sure if we could, you know, Doctor House, every person in the world you might find, but I don't think that's gonna love that show. I mean, right. sarcoidosis usually. Right? And I don't even know what that means. But, but so did you see anything in these questions that you definitely wanted to go over?

Jennifer Smith, CDE 37:16
I was just gonna go back to because

Scott Benner 37:21
because at some point, too, there were a number of questions about menopause to, and some women are asking about what about when they take hormone replacement? Is it going to happen, then? And I don't know. But it seems like the same as taking birth control to me, right? You're, you're adding hormones to your daily intake.

For the longest time, I believe that one of the sticking points of getting people good information about managing insulin was that it was hard to put it in one place, or to hold people's attention or for them to realize it was there so they could keep coming back. You know, there might be an article here or there or a story that would be helpful to you. But how do you condense it all into one place. And it turns out that this podcast is the perfect way to accomplish that, I would notice that even if somebody understood Temp Basal was really well, they might not have thought about pregnancy, or if they understood, you know, extended boluses, they might not have talked about how to use your Basal well, and that you were going to be lost if you didn't have all of this information in one place. But most importantly, this information needs to be easy to digest and easy to understand and listen to. Right, like you have to want to listen. And I think that we I think we've done that with this podcast. Well, now in my eighth year, with over 600 episodes, there is a ton of information inside of this podcast. It's a it's a compendium, it really is of how to manage your your insulin and live well. So I need you to look for the defining diabetes series. It might seem overly simplistic, but it takes the terms that you're going to be using every day and boils them down into easy to understand explanations. They're not long, they're fun to listen to. And you'll leave with a real understanding of what the terms mean. The podcast also has these diabetes pro tips, which I think are absolutely I think there's they're amazing, honestly, like it's not just because I made them. I see feedback from people every day about them. And I'll actually leave some at the end of the podcast for you. But listen to the diabetes protests, but you need the tools, right? You can't just you can't just look at the instructions to build a bridge not understand what a wrench is. So listen to the defining diabetes and then move on to the pro tips. Now there's also things like how we eat where people come on and talk about all the different ways they V carnivore, gluten free Bernstein FODMAP keto intermittent fasting ton of them, because I think that everyone's eating style should be represented. I don't care how you eat, I care that you know how to use insulin. That's all it matters to me. Once you know how to use insulin, you go ahead and eat any way you want. I just want you to be able to do it doesn't matter what you do. It matters that you can. That's how I feel. There are special episodes, me and Jenny Smith answering questions from the, from the audience, you know, they're called ask Scott and Jenny. In those episodes, we talk oh my god, we talked about so much how to combat the morning rise. How does carb absorption work? How to handle a high blood sugar? What is standard deviation advice for using Basal IQ, just so many different things. There's entire episodes that are just about mental health and type one diabetes, I have afterdark episodes that handle everything from heroin addiction to being a sex worker and having type one diabetes to smoking weed and everything in between stuff that other people don't talk about. But we talk about it here on the Juicebox Podcast. I also have over 10 episodes about pregnancy, an entire series just about the variables that may pop up while you're managing your insulin. You want to learn about algorithm pumping, we've got that covered to the Juicebox Podcast is much more than the diabetes Pro Tip series. I hope you take time to check it out. There's something in there for everybody. And there is a path to the A one C and the stability that you want. So whether you're looking for community or answers, check out the Juicebox Podcast, subscribe now, in an audio app, it's always free.

Jennifer Smith, CDE 41:49
And hormone replacement therapy is usually for the most part centered around like the menopause kind of time perimenopause, menopause kind of time, it's supposed to help to ease much of the hormonal transition that's creating some of the symptoms, things like the hot flashes, and the energy swings and the insomnia and the, I guess, level of irritation one woman may experience versus another. Right? So that's supposed to technically, even things out more. And it's a good question to actually ask, if you haven't, and you're considering are already taking the hormone replacement therapy, you know, asking your physician if they know anything, really about that piece in terms of what they should expect. My expectation would be that with the replacement therapy, if it's going well, then dose is well managed. Technically, you should have actually more stability, then in how you're feeling, which should also bring more stability to your glucose management,

Scott Benner 43:01
right? Well, I guess while we're in this area, what about somebody who's had a hysterectomy? Do they lose all of those, that the cycle is just gone? Right? So that is, but is all the horror or all the hormones gone to?

Jennifer Smith, CDE 43:15
So although I mean, there's a good question, because quite honestly, you could have a partial or you could have a like a total hysterectomy, right? I mean, so there are hormonal imbalances that can definitely happen with partial hysterectomy. It does, for the most part, from what I know causes less dramatic change in hormone levels than a full hysterectomy does. So in terms of that, you know, your hormones definitely shift because obviously there's nothing there to cause that trend of hormones change, right, there's a period right disappears. So, you know, overall, while there may be some initial management that needs to be done, I wouldn't expect that there would be as much I haven't worked with many women who have had hysterectomy. But I wouldn't expect that there to be as much fluctuation as they probably usually had. I mean, when the menopause obviously is kind of similar in that when that happens, obviously your ovaries stop producing enough hormones to continue the menstrual cycle. Right? So if you've had a hysterectomy, which includes removing the ovaries, you would then be essentially moved into sort of like a premature menopause kind of time. Right. So

Scott Benner 44:45
all right. Well, you know what, there's one person that asked such as a detailed question that I think yeah, the way they broke it down might be valuable for us. So her first question was, why does the body become more insulin resistant during different phases of the mess? cycle just laid out for you. And not that I think we haven't. But is the answer just simply there's more hormones at different parts?

Jennifer Smith, CDE 45:09
Right? And so that's, you know, initially when we're talking like what is the surge of the different hormones through the course of pregnancy or through the course of a menstrual cycle, right? So in terms of that rise up in insulin need, you know, there are a couple points of time for different hormones, one of them progesterone, as its kind of rising, in terms of, are you going to find out you're pregnant? Or are you now you don't know that you're pregnant, or you're not going to be pregnant, so you end up having a cycle. So then that climb in progesterone is, again, that typical time period before your cycle starts, that you would have insulin resistance creep into the picture. It may creep slowly, like seven days before you start to notice you've got that rise in blood sugar, okay, maybe you change up your overnight settings, or, you know, whatever it might be, as you get closer to your expected first day of cycle, you're going to see a lot more resistance. I mean, many women find 20 to even 40% more insulin need in that time period of climb in hormone. And then that most women experienced the most significant and resistance the day before their cycle starts

Scott Benner 46:21
the day before the cycle starts, which is the day Yes, leading to

Jennifer Smith, CDE 46:25
day before there, yes, there before their period starts. There's they're bleeding the event here, but in the event, there you go. Um, so you know, that could be, you know, a visual point of saying, Well, I'm not crazy, I didn't need to change my pump site and change to new insulin or nothing was really wrong. I see that this is the pattern and this is what's always happening. So how high did my blood sugars go? How much more insulin did it look like I continually used in the past two or even three months, so that you can expect it now. And you can make a I guess, a wiser shift in your insulin rather than just sort of like completely guessing. Right? Oh, I'm gonna take three units today because clearly two and a half yesterday did work well. Okay. But if you have some back knowledge, you can say okay, this is definitely how much more I needed. And I can adjust better here. Now,

Scott Benner 47:19
do you know there are months that Ardennes period doesn't begin on the first day of the placebo, it happens sooner. Which doesn't make any sense at all. She's definitely kooky and her belly, like like something's, something's going like when that happens. So is yet two days ago. I saw as much resistance from her as I as I had in the month. And I said to her, like something, you're going to get your period. Soon. She goes, I have like four pills left. And I was like, okay, so then yesterday, do all day. Like we had to cut her insulin back. Crazy yesterday. So when she got home from school, I was like, did you get your period? Because No, I still have a couple of days left. But her body acted like her period started yesterday starting and I'm like, I wonder if the bleedings now adjusting back to where it's supposed to be. I also wonder sometimes like Kelly's, you know, still still match traits, my wife still fertile.

Jennifer Smith, CDE 48:19
That's a good thing. The longer you actually have your cycle, the healthier for you. It reduces a lot of the risk of female related cancers. The longer you have your cycle, and the length of the cycle matters to not that this is diabetes specific, but it's a piece in the mix of bad cycle regular cycle and the longer you have it in the life the better for you. Yeah,

Scott Benner 48:43
well, that's good news. But what I was wondering was is you know how you kind of sync up the people? Yeah, like I I've often wondered if Arden and Kelly even being near each other is messing with Arden.

Jennifer Smith, CDE 48:55
Very likely because in college I had three other roommates. And at that point, we we all within a week had our periods at the same time. Yeah, like it was not a house

Scott Benner 49:14
buying a bigger trashcan. Okay, so this person's next question was, do insulin needs change? Only when premenstrual or does it happen around ovulation as well? I think yes. We've pretty much gone over that right.

Jennifer Smith, CDE 49:29
Yeah. And ovulation for some just in clarification, some women notice more significant insulin resistance around ovulation than they do in the pre cycle or like period start time, and it's often much shorter lived have a is a swing up, more noticeable rise. Post meals often tend to be impacted more if you're going to notice a change around ovulation, but it's only going to be like 24% 72 ish hours around that ovulation that you're going to notice such significant resistance. So again, we've got this like roller coaster of hormones going on. Making people feel

Scott Benner 50:14
crazy. Also, I watched a video about how to know when you're ovulating getting ready for this. And there's a lot that you can watch. Oh, geez, I learned a lot about discharge and cervix ripening and feeling sexual, and that it sometimes happens. And sometimes, to some people doesn't happen to others. Some people get many of the symptoms, some people get fewer none. You know, it, I love it when something spelled out to you like this. Here's what could happen, unless it doesn't. Or maybe it won't. But it could and you're like, This is not helpful, like, say something concrete or stop making videos. But it was really, I don't know, it was interesting. Anyway,

Jennifer Smith, CDE 50:59
here's a really good book I got actually years ago, before we even plan to start trying. It's called taking charge of your fertility. And it goes through, it's really, I think, I think that it should be given to women in general. Because even if you never plan to have children, it gives you a really good idea of how the female body works. Yeah. And it can, from just that standpoint, make you feel less like. Like, I've always kind of hated when people are like, Ah, she's getting her period. Like, that's the reason for all of these mood swings and whatever. Well. I mean, that's, quite honestly, it could be true. I mean, it's somebody meaning it in kind of like, not a very nice way. Yeah, but it is true that hormones change and flux a lot. But for you to know that as the person living with it, you don't feel silly about that. That's your body. It's supposed to be doing that.

Scott Benner 52:00
I'm 20% more feminist than I was before I started paying attention to this. And I was already on the lady side. And so I mean, listen, I've never once been given medical direction that began with start with a clean finger. But I've heard those words a lot. Now since I've been paying attention to this. And I just thought like pork girls, like you don't even like cheeses and seeing it happen to my daughter, like firsthand. It really does. I mean, if you're if you're not moved by it. I mean, I don't tease my daughter or my wife about like, Oh, your periods come in, you're acting. But I tell you when I was younger, I probably said it. But now, now that I've lived around it, I'm like, it's not. I mean, they should just say you should you should be thanking them, not telling them. Yes, sir. You know,

Unknown Speaker 52:45
I know, to some degree, and I'm very happy that I have two boys. Like, you're gonna go to your dad. This is Dan's department.

Scott Benner 52:54
You go to your father, whatever he says it's not gonna start with begin with a clean finger. I can tell you, nobody asked Bobby about that. And you you're lucky too, because you're not gonna ever be in this situation that Arden and Kelly are in where your periods are like, No, it just jerking you back and forth. On timing. Right? You know what I mean? Right, right.

Jennifer Smith, CDE 53:12
Because I have like I said, I have experienced that like in college. But I don't think at that point, I was even while I did a really good job of management as well as I could. I that technology at that point was not I mean, there was no CGM. I was still doing, you know, a lot of darn finger sticks a day to see where things were going. But I don't think I was as a two and two even wanting to pay attention to why something I was just like, Oh, I didn't even at that point. I was like, oh, it looks like I just need a little bit more. I

Scott Benner 53:48
mean, maybe we're a decade into having the technology where you can break this stuff down. Versus next question. I really want to thank them for this and I don't have her name here, I apologize. Is you know, she brings up what are ways to track it. Um, you can track it on a paper calendar, you can track it in an app. It's my intention to just like I said earlier, to in a quick, easy way, maybe even colors would work. Honestly, you know, green, yellow red for insulin. I would track insulin needs I would track when the period starting I would try to figure out as much about ovulation as I could. So you can kind of find that window in there about where it is. And I'll tell you to like it sucks but you could track your mood. You could track your you know, your sexual desire, like you can make all those little like clicks there. It's like yeah, you don't I found thinking sucked for women the whole time, is that things that from an outsider's perspective seem like choice can be driven so harshly by hormones, which could make you feel like you're not doing things purposefully like it's your body. Doing it

Jennifer Smith, CDE 55:00
telling you to do you telling you to do

Scott Benner 55:03
Yeah. Like, like, I would hate the idea of, I'm on a date, and I'm open to having sex tonight. Not because I want to have sex or because I like this person, but because my hormones are in a state where it's telling me

Jennifer Smith, CDE 55:17
they're kind of telling you to feel this way. Yeah,

Scott Benner 55:20
do this now. Because sperm will live in you for five days, and then we can get you fertilized and give you a good chance to, you know, bring in this egg along. That's, I mean, it's kind of which brings

Jennifer Smith, CDE 55:33
in a lot of interesting fact, especially for the teenage. Right? Yeah, where I mean, the majority of teenagers, this point are not considering conception. They're not they're beyond that, you know, for many reasons, but those are some of the things that your body is supposed to be telling you to do. And, you know, what's the reason? Well, eons ago, people were getting married when they were 1415 years ago, old and having kids at that point, in fact, you know, if you weren't married by the time you were like, 25 was like, over four

Scott Benner 56:15
are window. Yeah, right. We're five years away from dying, probably it's. Well, I mean, I listen, it's beautiful, like, you know, in a nature kind of naturalistic way. Like, it's amazing. I just found myself feeling badly that you could be having feelings or thoughts that aren't the ones that you decided to have. But then I kind of brought it out larger. And I thought, when my iron was lower, I wasn't who I was. Right? I mean, we're all just, you know, some dialed up level of different chemicals and hormones and impacts and everything. And, and I yeah, I think that I hate to say that I think this episode could have been like, Hey, you should track your period, and then make better decisions about your insulin. Like, I really think that could have been the end of it. And it Well, I

Jennifer Smith, CDE 57:03
think there's other I checked, there were a couple other questions in here that I think that do go. I mean, they they kind of go into, yes, that's the base, track your insulin, see what you need, and then make the decision on how to make your insulin delivery system. Do what you want it to do for you, right, but there were a couple of questions. One of them was on MDI changed my Basal in a certain point of my cycle to deal with increased or decreased physician resistance. And I should I also focus on adjusting my boluses I can say that, absolutely, you'll need to adjust at least your Basal insulin, even on MDI. I mean, when I was MDI, and had caught on to the fact of needing more, based on what my blood sugar was doing, I knew that I needed a certain dose, that was three units, I still remember it was three units higher than my baseline dose for the time period of resistance that I needed. So you know, in terms of that, I could always adjust and unless something shifted and changed, you know, I would have maybe used a little bit more, or a little bit less. But overall, it was, it's funny that I still remember, three units, four was always what I used when I had my period. So yes, you could use more. And if your doctor isn't directing you to do that. Our doctors don't direct us to do many things that we end up doing. This is not advice or recommendation to do that, but discuss it with them. But it definitely and bring in maybe some of the logs that you've kept and say, Hey, I'm noticing this, would you agree? I'm thinking I need this much more insulin, right? I mean, always check with somebody, obviously, if you feel that you need to Bolus is could they need to adjust? Absolutely, they could.

Scott Benner 58:58
Well, you know, I just did the math real quick three units is only like point 125 an hour if you're on a on a Basal program for a pump, so right, but but, but it might have been significant for you. Do you remember what your Basal was back then?

Jennifer Smith, CDE 59:14
Yeah, I do my Basal and overall was sitting at 12. And I needed 15.

Scott Benner 59:22
Okay, yes. Okay. So it's a big jump, even though it doesn't look like a big jump per hour. It is a big jump percentage wise,

Jennifer Smith, CDE 59:29
it was a big jump percentage wise and it was a bit I mean, it looks like a big jump like Gosh, going from 12 all the way up to 15. Oh my gosh, like, that's a lot more insulin right, especially when you talk about like adjusting things. Okay, we're going to add one unit more of your Basal insulin and we'll see how this manages things over the course of that whole 24 hour time period. Right. Um, I the other one that I thought was good to focus on would be using algorithm driven pumping systems as a female, the algorithm was not it wasn't built for this to deal with hormones. It was not it wasn't built for hormones, it wasn't built for pregnancy, you can successfully use it. If you know how to manipulate settings, right? I, I personally find that it's better for me to just adjust my baseline profile in my system. And then on the months that I am more resistant on top of that, then a temporary adjustment up using a temporary Basal or an override or, you know, whatever your adjustment is for the algorithm that you're using. I adjust up using that. Yeah.

Scott Benner 1:00:48
Is this whole conversation really similar to what you would have if you were talking about like, a teenage boy who's going through a lot of growth and hormone changes and stuff like that, like just it's just not on a cycle that you can see as well? Right?

Jennifer Smith, CDE 1:01:05
It's not on a cycle. That's as I mean, it doesn't seem to be from the team guys that I've worked with, it doesn't seem to be as cyclic.

Scott Benner 1:01:13
Yeah, predictable, right? It Right, right. This really is predictable, though, within reason,

Jennifer Smith, CDE 1:01:19
within reason, yes. And I can even say, if you're the person with the irregular cycle, let's say 25 days, one month, 29 days, another month, back to 30 days, and then back down to 25 days. Despite that, the things that you're seeing happen to your blood sugar, in that time period, will continue to happen for you. Yeah. Right. So even if your cycle length isn't about the same, if you start to see those in a time period, that could be soon enough to be close enough to like an early cycle. Or maybe you're gone back beyond that. You haven't seen changes yet. And up now I see changes.

Scott Benner 1:02:03
Okay, right. Yeah. Well, I was just thinking that you're talking about like variables and inside of variables inside of variables. You can, you know, you know, food, food cravings are not uncommon, right around hormone changes. So you could you could have forever thought, why is it sometimes I'm really good at nachos. And other times, I'm not really good at nachos. And maybe it's because once in a while you have nachos when you want them? And sometimes you want nachos? Because your hormones want them. And you're already in a situation that's more difficult. And then you add in food, because what was the question here is like, should I eat differently or exercise differently through different phases of my cycle? Which is a great question. And it may be think, you know, I'm not into telling people how to eat. But there are definitely foods that are easier on you that take less insulin that you might want to try eating, while you're having an increased need for another reason, because now otherwise, you have to increase needs correct difficult food and your hormones at the same time.

Jennifer Smith, CDE 1:03:05
Right? And the hormones are driving a desire for things that otherwise you may have very, you may have very easy management around, right. You may love nachos, but your typical serving of nachos is appropriate and and find. And if it's a hormone driven time, you know, you might eat much more

Scott Benner 1:03:24
of your doctor. You know, while we were adjusting Arden's birth control pills and getting it right, she couldn't stomach meat. Hmm, she was not a vegetarian kind of person. And for a while she couldn't stomach meat, like just getting away from me. She couldn't smell it, she definitely couldn't even think about eating it. And then as her as the pill, we found the right pill. And it got kind of like set in stone. Now that's come back a little bit.

Jennifer Smith, CDE 1:03:51
It must be something to do with the hormone levels in the birth control she's using because it's actually not uncommon for just thinking about hormones in general. Many women have some aversion to meet during pregnancy. Yeah, many women can't stomach red meat specifically. So I wonder if it's something hormonally? Well, similar. That was weird happening for her before it got regulated.

Scott Benner 1:04:18
I'm running around the house pointing to that my wife's like, that's crazy. Arden's like you don't think Arden just thinks I paid too much attention to her. So she's like, stop paying, like caring I brought up to the OB the OB is like, I don't know, I'm like, god dammit, I'm right about this. Like, no one's watching these people more than me. You know what I mean? Like, um, they trust me they don't be dead without me, Jenny. Like, in one way or another? My wife like, you know, like with the thyroid stuff like I'm the one who's kind of like stepped back like you guys hear me talk about on the podcast like being micro and macro. Like on my family on macro. Like I step back, I look for big picture stuff. And I don't worry, but when I start seeing stuff over and over again, I don't know. It's just who I am the guy just don't know, I worry about people. So

Jennifer Smith, CDE 1:05:03
that's not a bad thing necessarily bad

Scott Benner 1:05:05
for me. It's great for them. You've ever noticed me worrying about myself? But

Jennifer Smith, CDE 1:05:12
was this I think this kind of me answers some of the question I see and hear about age. Do How old was Arden when she had her first cycle? Do you remember? Of course you remember?

Scott Benner 1:05:23
No, I don't know if I do. It was a little later than her friends. Okay, maybe,

Jennifer Smith, CDE 1:05:31
as was, as was I? And a couple of questions here, you know, just relative to, like, when should I expect this in my daughter? Honestly, could be as early as age 10. Wow. Honest. And it could be I mean, I was, I was definitely late. I was definitely late and getting my cycle comparative to all of my friends. But I also think, in terms of that, my, my management wasn't then what it could have been if I were diagnosed in today's age, right. So I think that the management style that I had at that point was not managing well enough to allow my body to actually be consistent enough to start my cycle at the time that it technically should have started. Yeah,

Scott Benner 1:06:24
this is Jenny's third attempt to let you all know to go back and listen to all of the pro tip episodes. You can do a really great job of getting your settings right understanding how to make changes for yourself, how to Bolus for meals, how to keep high blood sugars from happening, like she is very artfully telling you, that's the ability and understanding is the is the firm foundation of living with diabetes. She says she's so nice about it when she says I'll just say what Jenny's saying y'all aren't doing a good enough job. You got to get in there and try a little harder. You know, it's funny, I think Artem was 14 Having just turned 15. And I don't remember the date. I remember the situation we we, along with a number of her friends. Were on our way to go swimming. And this was Arden's first time swimming with a period. And a bunch of little girls disappeared upstairs in my house, and came back 20 minutes later, disheveled, sweaty, rocked, and the end, the one girl goes, we couldn't get it in. And apparently, this is apparently at one point like a mechanic

Unknown Speaker 1:07:34
and how funny that they actually like. I mean, well enough with you that they actually announced it to like a guy. Oh, my God, I would have been like mortified, telling my dad something Oh,

Scott Benner 1:07:45
no, no, no, he was described to me as Arden was a car on a lift, and the girls took turns trying to change your oil and couldn't figure out how to do it. So.

Jennifer Smith, CDE 1:07:56
Oh, that's interesting.

Scott Benner 1:07:58
So that's about what happens around here usually. And well. Actually, I gotta say that's not usual. But but it didn't work out. And so I'm thinking it was the end of her 14 right around her 15th birthday. If I'm okay, I'm guessing right? If I'm wrong about that, then it's end. It's not 1516 She's been at this for a while. I think it's 14 to 15. But yeah, like this could you could have kids getting their periods, all kinds of crazy ages. Like what what they used to hear like the hormones and cow's milk or making girls develop sooner or something like I don't know if any of that's true. But you know, there are girls walking around sometimes where you're like, are they 20 or 10? Or like what he can't tell? Yeah,

Jennifer Smith, CDE 1:08:36
I know. Yeah. The I mean, I think that that's like a rabbit hole of we could dive in there. But it would be a long, long discussion.

Scott Benner 1:08:45
We should make euphemisms about holes while we're talking about periods. So. So I mean, do you think, let's see, do you think there's anything else like I mean, I feel like this is a good conversation, I mean, perimenopause, people are asking about different kinds of birth controls, like there are non hormonal birth control, like, ways, right. So, I mean, there's, I'll tell you, more than two people asked about Plan B. Whether as an whether or not that would have an impact on blood sugar's and I wasn't able to find that out.

Jennifer Smith, CDE 1:09:21
You know, I that is a really good one. I can actually ask my, my or my, my MFM. I can actually ask them if they have any reference to that having worked with enough women with type one. I don't know. I mean, the goal of that, obviously, is to not conceive. So it has some level of hormone shift to prevent pregnancy.

Scott Benner 1:09:49
You would think it's an overwhelming of hormones to kind of stop

Jennifer Smith, CDE 1:09:53
whether it has an impact on blood sugar. I don't know that's it's a really good question.

Scott Benner 1:09:59
I don't know enough about how that works. works? How about IUDs? Do they impact blood sugar's that I'm sure you've seen in practice, right?

Jennifer Smith, CDE 1:10:06
Right, those more they seem smoother than other birth control methods from what I have seen. So do they have impact? They probably have an impact in terms of initially having one. And then the outcome of what now your sort of monthly cycle if there is still one remaining, what does that look like? Do you see any shifts? I've, I've seen women who don't actually have any visible cycle whatsoever, right? Who have noticed a minor shift that appears to be cyclic, but most of them tell me that they don't even adjust around it. They just end up taking like a little more corrective at the next mealtime the correction seems to work well enough, kind of gets them, you know, back to where they want to be. And they never make any shifts in their insulin at all.

Scott Benner 1:11:03
I have to say that Ardens OB was pushing, pushing, she was pushing, she was saying if we don't find some stability with blood with birth control pills, she wanted Arden to consider an IUD now Arden's like a little young, like we walked out, she's like, the first thing she said to me is like, I'm not doing that. And I was like, gotcha. But it was, you know, she's like, you know, in the future, we might have to keep this in mind. Yeah, I don't I you know, that is another thing I don't know much about. But you look like you have something you want to say. What did you find?

Jennifer Smith, CDE 1:11:32
No, I was actually just looking up a little bit about whether I could find anything on the plan B and blood sugar specific to type one, but I don't really see anything at all that documents that

Scott Benner 1:11:48
Okay, how about so is PCOS somehow related to diabetes? And or no? Like, why is it just because I only apparently at this point in my life, I only talk to people who have diabetes that I I start thinking things are more common or

Jennifer Smith, CDE 1:12:03
right PCOS is more common in those with other metabolic shifts that include insulin resistance and PCOS can bring more resistance into the picture, right? Other metabolic things being have more difficulty with weight management, they have higher cholesterol levels may already have higher blood pressure, despite potentially doing all of the healthy lifestyle things to manage those. But PCOS is more common with the type two. But interesting. In the past, I would say five years, I have had more women more normal, like healthy body weight and healthy lifestyle who have actually been diagnosed with PCOS. And part of the part of the reasoning in terms of like sending them to their back to their doctor to say, hey, I don't understand I am doing everything in the picture of management. And I need so much insulin to keep things where they are. Something else has to be in the picture. So a mine is always Why don't we look for PCOS, because if that is in the picture, one of the long term even in women without diabetes with PCOS is a medication that's very common and uses Metformin. Okay, it helps to dial down the resistance and from the PCOS level, it helps with some of that cystic nature in the ovaries and it helps with evening some of that out in terms of hormones and everything. So Metformin is definitely a heavily used additional medication that could be you know, beneficial.

Scott Benner 1:14:02
Yeah, somebody mentioned Metformin in in one of those I forget where it was. I didn't bring that question over for some reason, because they were like, because they were talking about like, can I could I just use Metformin during certain times of resistance around my you can't stop and start it right?

Jennifer Smith, CDE 1:14:22
That's no that's not the way that Metformin is meant you know, if you're going to use it, we started a low dose, evaluate tolerance I mean, it's one of the older oral medications it typically for most people is well tolerated after you get over some initial like first week or so of like some stomach upset and as long as you're tolerating it, it increases to like more of a therapeutic level. And then you continue use of it you

Scott Benner 1:14:48
don't stop at use Advil during one section of your Yeah, I only got I brought it up here because if somebody was thinking maybe somebody else was thinking, I did not think that was a good idea. So okay, I don't know, like, there's this moment where I go, Are we good Johnny that I do we do it or?

Jennifer Smith, CDE 1:15:08
Yeah, I think, you know, I was looking at more of the questions just to make sure that P A mean in terms of talking specific like cycle, I think yes. Um, I mean, I think discussion around things like menopause and that kind of stuff are it's such a transitory time in terms of

Scott Benner 1:15:37
that ever, right? Like menopause can go on for years.

Jennifer Smith, CDE 1:15:41
It can go on from very long time. Absolutely. I mean, and that's really perimenopause. Right. Once you're fully in menopause, you have no longer had a cycle for a year's time. Right, then are you are menopausal. perimenopause starts with many women notice a shift in their cycle. Let's say you have had a regular 30 day cycle consistently, you kind of getting into the age of and what age in general about 50 ish, but women with diabetes have from research sort of proven to start earlier than the typical like age of 50, let's say. So any shifts in your cycle, without any lifestyle changes or anything like that, you know, now you're having 25 day, the next month, it's 30. Day, this month, you have three days and a really light cycle next month. It's really, really heavy and painful. And it's just not your typical, it could be very likely that perimenopause is kind of in the picture and there aren't any many women would say, Well, can I you know, get hormone testing levels done to see in this point of perimenopause, it's not typically recommended. It really isn't until menopause, that they would recommend doing testing of hormones to actually sort of prove the case that they have come to a level without a cycle, you're no longer ovulating. And some women actually haven't done the testing to make sure that they're actually not ovulating. From just like a sexual standpoint, they're just ensuring that they can't get pregnant any longer.

Scott Benner 1:17:19
Yeah. Oh, god help you imagine having a baby when you're 50. I'd be so tired.

Jennifer Smith, CDE 1:17:24
I personally i can't i

Scott Benner 1:17:27
i would be so tired. That's all I can think of.

Jennifer Smith, CDE 1:17:31
Yes, I mean, from an age No, I can't.

Scott Benner 1:17:35
So no, my God. Last night, Kelly was like, can you imagine if we had had three kids? And one of them was just a couple years younger than Arden. Wouldn't that be nice? And I was like, No, I don't think so. It's it's 930 and I want to go to bed. How would that be a good thing? That child would end up being feral? I'd be like, just try not to die. And I don't know if I'd have the energy to take care of it. I really don't. I don't know. I mean, good for you. If you do. I don't think I could. That it. We're

Jennifer Smith, CDE 1:18:01
good. I think that's it. We should be good.

Scott Benner 1:18:04
Alright, so thanks. On the whole that's everything. I'm

Jennifer Smith, CDE 1:18:09
probably not everything but you know, it's

Scott Benner 1:18:12
alright, cool. Awesome, Jenny. I really appreciate this. Thank you so much. Thank you. Yeah, you're very welcome. My friend Jenny Smith has had type one diabetes for over 33 years. Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She is also all over this podcast so if you like her check out the finding diabetes es has gotten Jenny the rest of the Pro Tips and so much more. Jenny does this for a living by the way you can hire her at Integrated diabetes calm Okay, I promise you euphemisms for periods so let's do it

Okay, some of these are going to be in delicate so stop listening now if you don't want to hear them. Alright, what do we got here? Strawberry week. Red and Red Army. Red wave. Red Ant is visiting men's which is short for menstruation. Riding the red wave code red. The red plague Aunt Rose is visiting red Castle entering the Red Sea tomato juice ketchup week. Ketchup week. That's not good. I don't I don't like that one. That makes me upset. What else we got here? Oh my god, that one's horrible. This is from in French. Fare do boo dime. I mean I don't think Big French but cooking black pudding. The hell's wrong with you people? The small little elves Niagara Falls. I have my things. The marquee red see? I feel sick red light red balloon. I have a flood lady days that time of the month, painters in the stairway what else we have here? special situation. These are Chinese special situation. Apple bread. Bloody Mary. That thing that comes in Japanese a Girl's Day. Blood festival once a month. Arrival of Matthew Perry. I do not understand that one at all. The Spanish say indisposed girl stuff. The frosting the steak. The frosting the steak. That's terrible. Little Red Riding Hood. Your devils the red cousin the vampire. I'm not even gonna say that one. What do you think of that? There's one I won't say that one's that one's terrible red tide. I prefer lady time. That's my favorite one. I'm also a fan of my baby box is trying to kill me. Here is another list. I painting the garage door. Moon time cranberry woman the Curse Girl flu. Girl flu is funny. Checking into the red roof in lady business Bloody Mary. Oh, i Ooh. I'll say it. Ready? Hold on. 123 the blob on the rag. I find that to be vile Crimson Tide. It's nice. I like that movie. Alright, I mean, listen, there's more than one of these obviously, you probably have a favorite. I just told you my favorites are girl time. My baby box is trying to kill me. And I did find girl flu very, very entertaining for some reason. Okay, if you're still listening, I really appreciate it. Thanks so much. I'll be back soon with another episode of The Juicebox Podcast. Make sure you check out those pro tips from the beginning. Listen through it'll be well worth your time.

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