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Scott Benner 0:00
Hello friends and welcome to episode 739 of the Juicebox Podcast

Welcome back to the bold beginning series, today's episode with Jenny Smith and I is all about carbs. I think I'm just gonna call it carbs, carbs. Anyway, while you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry take the survey that survey taking part less than 10 minutes easy questions about type one diabetes, your answers help people with type one diabetes and they might help you as well go find out T one D exchange.org. Forward slash juicebox. And if you're looking for Jenny Smith, she works at integrated diabetes.com You can find her there

this episode of The Juicebox Podcast is sponsored by the Dexcom G six continuous glucose monitor. Get started today@dexcom.com forward slash Juicebox Podcast is also sponsored by Omni pod makers of the Omni pod five, learn more ami pod.com forward slash juice box the show is also sponsored by the Contour Next One blood glucose meter contour next one.com forward slash juice box and by us med get your medical supplies at us med.com forward slash juice box or by calling 888-721-1514. The podcast is also sponsored today by Ian pen from Medtronic diabetes. You can find out more about the in pen and ink pen today.com. Last but not least, the episode is sponsored by je voc hypo pen, je voc glucagon.com forward slash juicebox. Now don't worry, I'm not going to start piling up 17 ads on every episode I just had a thing this week. So instead of two longer ads, you're gonna get more shorter ads. Just this one time on this episode right here. I hope you understand I hope you'll listen it's going to be fun. I'm going to try to do them without stopping the recording. It should be crazy. I'm gonna need a stopwatch to Anyway, I'll see if the ads we'll see how I can do with this. And to the advertisers. I'm sorry, I didn't clear this with you. But things come up. You know what I mean? Pico? Hello, Jennifer, how are you?

Jennifer Smith, CDE 3:05
I'm great. How are you?

Scott Benner 3:06
I am I'm doing okay, I am looking through our bowl beginnings list. We are little more than halfway through recording. And we are upon carb guidelines and impact of food. But just how the statements, questions and concerns sent in by people were categorized by our dear Isabel. So it's a bit of a long list. But I think we can get through it. Cool if we try. So there's two. There's no There's two thoughts here. Right carb guidelines like what does that mean impact of food? What does that mean? I think we're gonna see by listening to people's statements first first one out of the box. All carbs are not created equal. That comes directly from the podcast. So somebody is speaking from a perspective of having been diagnosed, listen to the podcast and looking back now thoughtfully and saying what do I wish people would have told me the beginning that all carbs aren't the same? Correct. Okay, now, you and I talked about this. It feels like constantly to the point where sometimes I'm embarrassed that I don't have other examples. When I pull up like two foods, there's two foods that pop into my head every time and I I'm always like, I should come up with different foods. That's a conversation. I'm having these. There's consistency there then, right? Yes, my brain is pulling from the same place over and over again. But you know, the basic idea here is that you're going to be told to either count your carbs and Bolus for you might be told to eat on a schedule or eat a certain amount of carbs. But no one ever explains to you that all carbs don't impact blood sugar's the same way. You're taught the number. Right right. And that is come forgetting in the beginning to people like, Oh, you just count, you know, and that's why you'll hear some people go like real, like, heavy into, like, I bought a scale, it goes down to the like, the gram, you know, like, if I if I measure this correctly, you know, that works mostly. But it's not a perfect system, right? Correct. From a different person counting carbs was a huge stressor for us. We needed easy ways to count carbs. And we needed to understand how different things would hit differently. So let's talk about that a little bit. What do you think, is the benefit of telling people that and what do you think the problem is with telling people that

Jennifer Smith, CDE 5:43
I think initially the benefit goes along with the first line of information, which is counting carbs, because you have to learn, many people don't read labels before they're diagnosed, right? They may look at certain things on it, but they're not really looking specifically at carbohydrates, and learning how to count the grams of carb. But I do think that along with that conversation, if you're going to show somebody and tell them how important it is to count carbohydrates, and give this medicine, that's, that could be really heavy and action based on what the what they know now about food and how the food works with their insulin, you essentially should be telling them or giving a baseline list of these foods are slower, these foods act a little faster, these foods act really, really fast. They may all have the same carb amount, based on portion. But they may have a very different onset of action in terms of what you see happen to your blood sugar. So I think, a simplified chart, not only for carb counting, which is a really basic easy concept, for the most part. Moving into that though, the bigger discussion should be about how those carbs could show up differently in terms of your CGM trend, especially or even fingerstick values if you're doing enough of them, because you don't have a CGM yet. And I think, you know, taking that one step further, if, if you do have a really good educator, they should really sit down with you. And they should ask you what, what are you eating, not give you a random list, and you maybe eat three foods out of the 50 that are on it. And you say, well, this wasn't very helpful. Sitting down and giving them what you eat or what your child eats and getting feedback on. What should I expect of these foods? Do

Scott Benner 7:42
you think that sometimes when clinicians give lists of foods, they see it as an opportunity to change your eating habits to better things? So they write stuff so the list consists of like broccoli, and you know, things that they're like, I'm pretty sure people don't eat enough broccoli. So we'll put there's one that you say all the time that I stopped myself from laughing constantly. Quinoa. No one eats Kean rocket Jenny, just you and four other people. Right? My kids like, Alright, listen, but you know what I'm saying? Like they think sometimes they give you the list they wish you ate not the list you actually ate. Right, right. And

Jennifer Smith, CDE 8:21
which is, it is unfortunate, I would say, I don't know, I would have to ask honestly, like how many people were really given this random list of stuff that looked like it was supposed to be healthier, but they never really ate versus just the typical list of carb counts for foods. That's like a general list, right? The 15 gram per portion kind of list. And I can tell you those lists from when I was a kid are there there. Many of them are not like great foods, many of them are

Scott Benner 8:54
processed. I just find myself wondering how many nurse practitioners who on a set on a on a Saturday morning hungover eaten honey smacks would never tell you how to Bolus for honey snacks. So because it seems like you'd be saying, hey, it's fine to eat a Twinkie. You know what he mean? Instead of saying, Look at Twinkies not great for you. There's here I could sit for 20 minutes and tell you why not eat this thing. But I think it's possible you're going to eat it. And it would be nice for you to know how to Bolus for it. And I don't think that conversation happens. But I want to know want to go back a little bit to something you were saying a minute ago about how nice it would be to explain to people, here's a list of foods that will kind of impact at this level. And here's a list that might hit a little harder. Here's a list that might hit a little quicker. Whatever it is. It made me feel like the problem with doing that. If I'm thinking about how to explain things to people, is that you're in this short doctor's visit. And now you're going to start telling them that foods not food. This food is Mike Tyson and this food is Sugar Ray Leonard and this food is You know, 150 pound guy who's only been boxing for three days? And or I don't know how so I'm trying to think like, what would you say to somebody would just say, Look, when you think about speed, there's the kind of speed that a Camry creates, there's a kind of speed that a Mustang creates, there's the kind of speed that a Tesla creates. These are all cars. But the way they generate speed is differently, I don't know how you could save to someone and explain to them, you're going to eat a baked potato. And it is going to make your blood sugar higher in the future. Right, it might make it really high, because it because of the impact that's going to have for the lasting effect it's going to have in your system, but it won't jump up in the air. Like if you took out a ring pop and just started sucking on it.

Jennifer Smith, CDE 10:46
Correct. In fact, one of the ones that I explained that way. It's grapes. I call them Sugar Bombs. I mean, they really are they are you eat them. It's why raisins are also one of the like, treatments for low blood sugar, because they impact so quickly, that they will cause a quick spike. So I that's a, it's a good way to think about kind of reaching somebody at a level that they can say, Oh, I understand that. That totally makes sense.

Scott Benner 11:16
Around this time of year, cherries come into season. Yeah. And Arden will just take a bowl of cherries. And I swear to you, I think sometimes she might take 10 or 11 units of insulin to eat a small bowl of cherries, right? It just, it's like she's having a popsicle over and over and over again. Like as she's sitting there, right? It's funny, because before diabetes, I would have thought cherries, that sounds healthy grapes, that sounds good for you. You know, like I didn't pay much attention to nutrition. Prior to diabetes. I was not raised well, in many different ways. But around food was just really broke. You know, like it was like meatloaf night you got potatoes. But that night was chicken with chicken came green beans, like we were just my mom was trying to make $70 Last week, you know what I mean? Like she didn't, she just didn't want us to die. And she didn't want us to be broke. So you know, like, so? It is, um, I don't know, like I said, kind of like circling back to it. There has to be a way right now to explain to people that more than all carbs are not created equal. Although, after doing this podcast forever, I don't know that that's not the best thing to say is that you have to be aware that these foods are going to impact differently. And you start to talk about it a second ago, that processed food is going to be more difficult to Bolus for than

Jennifer Smith, CDE 12:45
simple simple style real food. I mean, to be quite honest, it food that is real, is not broken down. It hasn't been processed through a factory someplace transformed into this dinosaur shape. You know, I mean, I use the phrase which has been well overused in on online and describing food. But if my grandma didn't know what it was, then it's probably not real food or it's probably processed and started out as food.

Scott Benner 13:24
Well, so the way the way my brain does it because it's funny you said dinosaur shaped, which it's really funny because when Cole was little, one of the first nutritional decisions I made as an adult, was if I'm gonna give the kid chicken nuggets, I'm gonna buy chicken and a bread at myself, and I'll bake it in the oven, and I'll give him nuggets. And when we first did it, you might have thought I don't know if you saw this. This video lately. Apparently, there's an aquarium overseas because of budget cuts. They had to go to a cheaper grade of mackerel for the penguins. And they hold them out and the penguins turn their heads away and won't they like won't eat them, like, like, and so that was cold when I first gave him fresh real chicken nuggets. He ate them and he was like, What is this garbage? Gold this is just a I overspent I bought chicken breast i cubed it up nicely. I even I don't know if you know this, but when you slice meat, there's a direction you can slice that makes it easier to chew right? Even I went that far Jenny breaded it nicely. I put seasoning on a nice daddy mother Jennifer, you know and then then the kid then he acted like I was trying to give him one of these cut rate macros. And but after a long time, it just switched and just noticed how his palate just changed. He doesn't want a frozen dinosaur that somebody said has chicken in it because I'm not certain it was chicken. You know what I mean? And so we did that. And then we did it in as many places as we could but but my thought here You're for people. And you were just saying that a second ago, when you look at something, you look at a piece of chicken and somebody says you what's in that? Your answer is? Chicken, Chicken. Yeah. When someone says, that's a grape, what's in that? Your answer is, it's a grape. When somebody says, hey, what's in that Oreo? You don't go Oreo.

Jennifer Smith, CDE 15:20
Let's look at the ingredients on the package. How many are there? Can you read them? Do you know what they are?

Scott Benner 15:26
Right? If you there are, I don't know how many things and I don't even mean to just pick Oreos, but anything like that. There's 2030 things in there. And you don't know what any of the more and this is this oversimplified thing I've been hearing people say for decades. And it just becomes more important when you're the one that has to figure out the insulin, not your pancreas, because you can your body can hammer through a lot of crap. Like I'm pretty sure we could eat stones and get away with it for a little while. Don't need stones. But you don't need mean like like, we're not birds. Birds eat stones,

Jennifer Smith, CDE 15:59
birds, some birds, it helps their digestion if you see birds on the side of the road. Totally random thought. But yes, they're like picking stones you'd like why is that bird picking through the stones? It's because the stones in the digestive system help to? Oh, I don't know that it's all birds. So if you are a bird expert, I am certainly not stepping on toes. I I know that birds eat stones, not all of them

Scott Benner 16:24
do. I thought you just said birds because I said penguins earlier. But no. But my point is, first of all, I can't believe I have to say this, please don't eat stones, your body cannot process. But my point was is you can put a lot of crap in yourself, especially when you're younger, and your system can fight through it. It doesn't mean it's good for you. And it doesn't mean you're not going to have short term or long term, like health effects from it. But I think that thing tricks us a little bit. You know what I mean? Like, you go out on a Friday night, and you have nachos and this and you have pizza and you're drinking beer, and the next day, you know, someone says Are you okay? And the answer is no, I'm not okay. And then more of the answers, you probably shouldn't go in the upstairs bathroom, you know, like, like, five or six hours later, you feel okay again. And that somehow, I don't know how humans think Jenny, but somehow we don't think about the time spent in the bathroom, clutching the wall. Talking to Jesus.

Jennifer Smith, CDE 17:22
It's almost like our taste buds when out, right? The memory of the of the taste, and maybe even the social experience that went along with the taste and the enjoyable like eating experience. All of that is more of the forefront of the brain. And Out goes the experience of the bathroom that you spent four hours in. Yeah, you know, it's it is I humans are. We are interesting, right? And really interesting.

Scott Benner 17:50
And what I see anecdotally is when people are diagnosed with diabetes, their first thought is generally I don't want to lose my freedom, about how I eat. And I don't want you to either. I mean, if you listen to this podcast long enough, you'll know I think you should eat whatever you want. I just want you to know how to bowl a sport. So that's what we're talking about here. Whether you're going to eat the Twinkie or have a pile of nachos, or eat rice, quinoa, you know, or somewhere in between, right?

Jennifer Smith, CDE 18:18
And I think what it boils down to honestly is given like the more newly diagnosed and this information coming to them, carb counting, know that the carb count is like, it's like the base step right? Now you know how to count how much you're eating. But the next step of that and very close to it really is, what kind of food is it? Is it a slow action kind of like a turtle? Or is it fast? Like the hair, right? I mean, if you imagine those two, just simply, it'll help you make more sense. And then look at what you're already eating. Regardless of what somebody told you should be eating or shouldn't be eating anymore. The easiest thing to not change yet another piece of your life. Take what you're eating, and see how things look after you eat those foods, and you can say, Okay, I think this is enough insulin, but it looks like my blood sugar rose up too quickly. Gosh, Scott was right. Maybe I need a little bit more Pre-Bolus Right. So let's try that and be this is more of a high glycemic food. It's not really so slower medium like I thought it might be.

Scott Benner 19:33
So yeah, you know, I'm funny. I'm looking at two different statements here from two different people. And if you want to know why it's easy for people to get confused. These are two statements that are I think, pretty consistently told to everyone and they completely they they clash with each other right? The one person says the hospital made it seem very black and white. You eat X amount of carbs and you take x amount of insulin and just go on then live your life. And the next person says, it would have been nice to understand that all the free carbs they were telling me I could eat weren't really free. And it's it you know, so what? Which is it? Are there free carbs? Or are there not free carbs? And every card gets covered? The real answer is in between? It is

Jennifer Smith, CDE 20:18
yeah, it is. Absolutely, I think the first statement is take this amount of insulin for this amount of, of black and white carbs, regardless of what it is, and it should cover that amount of food. But now we're digging deeper into insulin action and food digestion. So it's it's a, it's a road kind of that veers off of take the insulin to cover this amount that you counted. It may be a timing thing, you know, something like a big bowl of cherries, for example, you definitely need that insulin. Now, the same amount of carbs though in a grilled chicken caesar salad. You may need that same amount of insulin, but I can guarantee you don't need it all up front.

Scott Benner 21:06
Do you think that they talk about free carbs more with kids, because they've they've already given the kids a wide target range to begin with. So if your kids at and drifting down, you can give him this, I don't know a certain number of these things. And it's free. Don't bother giving insulin for it because they know you need it to fix the blood sugar. And the bigger idea about insulin you don't have yet. All right, ready, this is off the top of my head. I don't have anything in front of me. 30 seconds. For each one, I have a stopwatch in front of me and go the Dexcom G six is a continuous glucose monitor. You wear it to see your blood sugar's speed, direction and number. For example, my daughter's blood sugar is 104 right now, and it's steady. I just saw that on my iPhone. You could actually do that on your iPhone or your Android device. dexcom.com forward slash juice box. Check it out. It is absolutely one of the greatest things I've ever seen managing insulin dexcom.com forward slash juice box 30 seconds. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. Go to contour next one.com forward slash juice box when you get there, you're gonna know everything you need to know about the greatest blood glucose meter I've ever seen, held or touched fits in your hand wonderfully. It's an amazing size. It has a great light, it's easy to read and it's incredibly accurate Contour Next One, go to contour next one.com forward slash juicebox that was 30 seconds. So okay, now oh my gosh. US med go to us med.com Ford slash juice box or call 888-721-1514 To get your free benefits check. US med is where I get Arden's diabetes supplies. They're the number one distributor for Omnipod dash, they have over 1 million diabetes customers worldwide. And they always give you 90 days worth of supplies and fast and free shipping with that one over 30 seconds. Sorry, they carry everything from CGM to all of your diabetes needs us met.com forward slash juice box links in the show notes links at juicebox podcast.com. This one's not going to be easy. I have to say certain things. Okay. There's no way I'm gonna get this done. You want it? Oh, I'm scrolling up. Do you want an insulin pen you're not quite ready for an insulin pump, but you'd like to get some of the functionality that insulin pumps offer. If that's you, you're looking for the in pen from Medtronic diabetes. You can learn more and get started today in pen today.com in pen pairs with an app on your phone to give you much of the functionality that you see with type one diabetes and insulin pumps but you get it with a pen. In pen requires prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information visit in pen today.com The Omni pod five baby it's here automated insulin delivery system it is available on the pod five is the only tubeless automated insulin delivery system that integrates with the Dexcom G six CGM and it uses smart ingest technology to automatically adjust your insulin delivery every five minutes helping to protect against highs and lows without multiple daily injections. The Omnipod five is currently cleared for people with type one diabetes ages six and older and if you have the option, and you have the option, dammit to control it from a compatible smartphone, Ali pot five is also available through your pharmacy which means you can get started today. Damn, which means you can get started without the four year Durable Medical Equipment contract that comes with most insulin pumps. Even if you're currently in one RT with another system. So to get started today with the Omni pod five, go to omnipod.com forward slash juice box for full safety and risk information, a list of compatible phones as well as clinical trial claims data, go to omnipod.com/juice box. Alright, I don't think I'm going to get this last one in. But it might go a little past the music already. G voc hypo pan has no visible needle, and is a premixed auto injector of glucagon for treatment of very low blood sugar. In adults and kids with diabetes ages two and above, find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or phaeochromocytoma. Visit G voc glucagon.com/risk. And the bigger idea about insulin, you don't have yet

Jennifer Smith, CDE 25:51
it could very well be and remember a lot of kids initially diagnosed are very sensitive to insulin, and may have a ratio that's something like one unit for every 50 grams of carb, well, then really, if you're starting out, you don't have a pump yet. And you're using multiple daily injections, and your child wants to eat five grams of cucumbers. That that's free. There's there is no way to dose for that. Right. You know, well, I shouldn't say that. You can dose you can dilute insulin, you can get micro doses of rapid insulin, but that's another that's another regular.

Scott Benner 26:27
Yeah, it's funny, as we're talking, I think, here are the words that are missing when people are talking to clinicians, right now. These foods are going to be free. But that probably won't be like that forever. It's the it's the those things are the things that no one tells you. Because as I'm reading the I mean, we're going through these bold beginnings things. And the thing that sticks out to me most is that what you get told in the beginning really, really sticks in your head. Yes, you know, and then when things morph and change your honeymoon ends, or your kid gains 20 pounds, and all of a sudden, a half a unit, it's not enough to you know, just tank them completely. Once things change. People hold on to the rules they were given at the beginning, and then the rules and reality don't match any longer. And no one ever comes by and tells them Oh, that's fine. This stuff changes, you know, be flux.

Jennifer Smith, CDE 27:25
Excuse me, I think also that goes right along with that is it is the concept of change. And people rightly so they take the information they have been given as if it's written in stone. And this is not going to shift. Again, some explanation needs to go along with it in terms of especially kids who have very fluxing needs for many, many reasons. Not that a newly diagnosed adult doesn't initially to, but I think more so for kids, especially since their insulin doses may be microscopic. To begin with. You have fried foods for a child who's really residing on just a couple units of Basal insulin, and really doesn't seem to need coverage at all for meals yet. Yeah. Eventually, those foods that look like they're free, will need to get covered. Eventually, as their insulin needs creep up that five gram treat or snack in the afternoon, as their insulin to carb ratio becomes more aggressive, they're going to need some insulin to cover what you didn't really need to give insulin for before

Scott Benner 28:33
this other thing that happens to people where they get told to eat a certain amount of carbs at a meal. Even when they're using a fast acting meal insulin, that again, I think of his lazy, the description that was given to them because I think what's really happening is the clinician saying to them, Look your kids so small, I don't know how to break this down beyond a half a unit of insulin. So you're gonna have to eat 20 carbs. So you can give this kid a half a unit of insulin correct. But instead the takeaway from the family is he has to eat 20 carbs every time he sits down. And then they start getting into the like, Well, how do I eat 25 carbs, no one tells me that. So now if I want more than 20, I have to eat 40. And then and then kids can't do that. And because it's too much food for them. And again, if someone would have told you the reason we're doing this right now is because we just can't get the amount of insulin low enough to tell you how to Bolus for eight carbs. But don't worry, kids gonna gain weight, this is all going to change, honeymoon is going to end etc, etc. Again, I think it's the rest of the words that nobody speaks that are always what causes the problem.

Jennifer Smith, CDE 29:40
No, yeah, that's absolutely correct. Especially, you know, again, for a kiddo who's like a one unit might cover a warming meal, but they're three years old and they're not going to eat that large amount of food. Then you have to break it down a different way for them and it takes It takes individualizing the care from the start. It does.

Scott Benner 30:05
What do you think about the idea that most people newly diagnosed are going to be MDI. And that the way I heard somebody told me the other day that the podcast is about, it's for pumpers. And I thought, I don't think that's true. Like, I think that what we talked about works fine. If you're doesn't matter how your insulins getting in, like, you lose, right, can't do an extended Bolus, you know, without a pump, you can't shut your Bayes law for Jack it up without a pump, okay. But the rest of the stuff is just about putting in insulin at the right time using the right amount the right time.

Jennifer Smith, CDE 30:39
I, I wonder if some of that timing though, I can say I mean, we do refer to things like extended Bolus and Temp Basal are using, you know, the fancy features of all the other algorithm driven kind of systems that are out there. But from a timing perspective, it covers both bases, it covers MDI, and it also covers pumping. But in a sense, you have to be okay with potentially giving more injections, on MDI, in order to cover the food the way that you want, and get the sort of out, you know, the aftermath covered the way that you need it to be. So you can do that. And from the beginning, again, we've talked about this in stacking right, from the beginning, people get scared of stalking their insulin, and they need to learn from the get go that if you're going to eat little bits, as many little kids do a little here a little here a little here, you may have to figure out how to get the insulin in in the right amount to cover that little bits of nibbles along the way. Yeah.

Scott Benner 31:52
I have this thought from this person here that I don't I kind of don't see how it fits into this conversation completely. But it is really interesting to me. So I'm gonna mark it and come back to it at the end. There. Oh, yeah. Okay, hold on. We were told snacking under 15. Carbs was free, just so this person was just told anything under 15 carbs was free, not just certain foods, like you can have a cheese stick, or you can have chicken or something like,

Jennifer Smith, CDE 32:18
I wonder what their initial dose of insulin was like to his I mean, 50. And as we've the 1515, right, anything under 15 is free, but I can use 15 to treat a low blood sugar. Right? I that's confusing.

Scott Benner 32:34
Yeah. I and then you wonder if this is what they were actually told, or if this is how they remember it. And or if this is exactly what they were told. And the person telling them was, was conflicting ideas. Yeah. Not all carbs are the same. This person says, I had anxiety about food and insulin, it took weeks to really get an idea of what a balance look like for me. So I, I can't tell you, I mean, I don't have diabetes, right. But I can't imagine what it feels like to be given this medication being told, Look, you have to use it. If you don't use it, you're gonna die. And if you use too much of it, you're gonna die. And it's connected to everything you put in your mouth. I don't know how that that must freeze people. The idea that that eating disorders come out of type one diabetes frequently is very easy to see. It's not at all shocking, right? Because of that feeling, like this paralysis of analysis that you must get I hate using terms like that. But But that idea of just like, What do I do? And then everything you've been told, is scattershot. It seems, I mean, some people come away with great, you know, with great information up front, but for the most part, I don't get to talk to those people very frequently.

Jennifer Smith, CDE 33:53
Right. And I think it also speaks to the very individual nature of how you first teach somebody about their diet, you know, their diagnosis with diabetes, you can't, from my perspective, you can't approach somebody the same way as you did the person three hours ago, there is no way to do that from a newly diagnosed standpoint as well. You still have to ask enough questions that help you to individualize the care so that their lifestyle while it's going to be impacted, is a little bit more. It's a little easier to get them to understand how to do these things within what they had been doing before diagnosis from a from a comfort level and there are some personalities that certainly require some additional assistance sooner than later.

Scott Benner 34:50
Yeah, no, I mean, obviously, there are some people who just get like, I'll do it tell me what to do. I'll do it right and there's some people are like you're not changing my life. And again, Anywhere in between a we just tell them all the same thing and sent them home? Right? Is this accurate? This person says, the kids are hungry for a few weeks after diagnosis, like overly hungry.

Jennifer Smith, CDE 35:14
That's in a general sense, especially if they have lost a fair amount of weight. Because their body was essentially eating itself. That's the easiest way to explain it. You know, when the blood sugars are running so high, obviously, they are losing a lot of calories through urine excretion. And so after diagnosis now, when their body actually is able to, gosh, I can grab this food and I can pack it away, I can store it, absolutely. Kids can get very, very hungry. They're also in a stage not to say that adults or you know, those over the age of growth couldn't also be hungry again, especially if they've experienced that extreme weight loss before diagnosis. They may also their body is just telling them, Hey, we need to put this back on. You lost a lot. We have to sort of recoup what what was kind of given away, but kids are growing already. So you could expect them to be hungry,

Scott Benner 36:12
right? Even if they're just more feeling healthier, because they have insulin, and they're getting back to where they were. But I mean, Artem was down, excuse me, Arden was down a fair amount of weight, she was small, and she was ravenous for a little while as well. Somebody just says here, it would have been nice if somebody gave us the rundown about the glycemic index and glycemic load. If you go to the Pro Tip series, there's an entire episode about that. Earlier in the podcast. Jenny touched on a little bit about giving you lists of foods that impact differently. But if you I was going to say if you want to understand but you really have to understand it. So go find that episode. Understand you know how how words that seem a little weird and confusing and stuff you haven't heard before are really important glycemic index and glycemic load. While we were in the hospital, we were told not to do more than 45 carbs a meal. So she says this was clearly BS. We felt the need to go to the store and buy a ton of diabetic food. Of course, we haven't bought any of that sense. So it's just a it's just an insight Jenny into how saying something to someone incorrectly or not conversating with them to make sure they understand your intent can send people down these crazy rabbit holes. I don't know that people can afford to go to the grocery store and spend hundreds and hundreds of dollars re fitting their home only to find out later that magic spoon cereal tastes like not good. I'm sorry for those of you who like it.

Jennifer Smith, CDE 37:46
I like magic. Cereal is the one process thing and I will say it is processed I mean it there is no doubt about it. If and when I have it we do it for like a road trip or like to go camping or something because it's it's a little bit easier. And it certainly doesn't have bad impact on my blood sugar. I have tried some of the other brands out there, which I will not name. But the magic spoon is definitely one that I can I can say works like it says it's going to work glycemic ly. And many of the flavors. I won't say all of them, many of the flavors are palatable.

Scott Benner 38:24
Art we tried one said, I'm gonna have to bleep this out. Arden said where are they trying to approximate Hold on a second. I'm making myself laugh unintentionally, or were they trying to approximate what a unicorn say, almost tastes like he did not like it at all. He didn't like the garbage. But that's fine. There are a lot of people who love it. And I think that's terrific. But but the point is, is that if you say something specific to somebody, you can never have a meal again, that goes over 45 carbs. They think well, how are we going to accomplish that? Right? You know, now they're in that one aisle at the grocery store that nobody goes into?

Jennifer Smith, CDE 39:07
is unfortunate. If you go back, you know, I don't know, 15 minutes ago when we're talking about real food versus processed food, all of the all of the food that is labeled diabetes friendly or whatever they're calling it now. It is processed Yeah, there is nothing. There is nothing in it. That is there are a few pieces, I guess a few ingredients but most of it is artificial sweeteners of some kind added fibers of some kind or some nature added protein powders of some nature, right? I mean, so you're better to go home and at least just keep eating what you've been eating and maybe then asked for help cleaning it up or figuring it out or whatever. Or just go to the produce

Scott Benner 40:02
weighed real food. Yeah, what is that they put in the diabetic. I wish people could see me making the finger quotes, but diabetic case sort of a tall, right. And if you get too much of it right,

Jennifer Smith, CDE 40:14
the bathroom will again be your friend. Yeah.

Scott Benner 40:17
Because things will be flying in all directions. Don't eat too much candy. Just eat regular candy, learn how to pull it sport for God's sakes. Right? Yeah. This is interesting. This person says that they were told that anything was free under 15 carbs. On top of that they were told not to Pre-Bolus their meals. And they said that these two things together made any kind of stability in their blood sugar impossible. Absolutely. Yeah. Right. I mean, and I wish someone would have given me a comprehensive list of actual zero carb snack. So this is the I

Jennifer Smith, CDE 40:56
don't know, I don't know who would have said, I really don't that. It makes me really, really sad that there are that there are education teams out there that are giving this kind of information. Really, I am like, I have nothing. I don't really even know what to say about that. I really don't. Jennifer's mortified. Yeah, I am. I'm mortified. Honestly, from a professional level, I am mortified that somebody would have given that information.

Scott Benner 41:25
Yeah. So here's the next thing that's gonna happen. Pizza's gonna get ruined for you. You've been diagnosed with diabetes. And, and there's this thing that through 35 minutes of talking here, we have not gone over which is yes, food. One broccoli hits your blood sugar in a certain way. And yes, mashed potatoes hit in a certain way. And yes, mashed potatoes will hit differently if you put butter on it. And if your meatloaf is just meatloaf, that's one thing, if you put gravy on it, it's another thing. What happens when you eat them all at the same time, right? They're all in a mixed meal where they all live. The way I like to think about it, when I'm thinking about insulin is where they all live on their own kind of timeline of existence in your body. Like an impact timeline, the broccoli impacts with a certain amount of force over a certain amount of time, as does the butter, and the potatoes, and the beef, and the flour and the gravy and all these different things. And you just thought it was gravy and mashed potatoes. And now you're realizing, oh geez.

Jennifer Smith, CDE 42:30
I think one concept there is the the typical, the typical mixed meal of proteins, carbs, and fats, right? All the macronutrients in a portion that should be eaten. Should should have a typical absorption or digestion that goes along with the Action Timeline of our rapid acting insolence. Okay? The, the larger the portions get, or the higher in one macronutrient versus another, like, really, really large amount of the meatloaf and like a spoon of the mashed potatoes and maybe one stalk of broccoli, right? Do you see there's a there's a definite difference there. And that goes back to impact on blood sugar and what you may end up seeing happen. So portion comes into play, to not only just carb counting, but a portion of a combined mixed healthy meal. And the impact that you're going to expect to kind of see Yeah, so

Scott Benner 43:47
the idea being, we'd all be okay, if we took a handful of potato chips once in a while. Eating the entire bag of potato chips has a different impact on your body. Yeah. So alright, so back to pizza. And Pizza gets described throughout the podcast a number of different ways. But pizza is not just pizza, it's flour, and it's cheese. And it could be meat, right? Or it could be vegetables, it gets the sauce. There are all these different things on this one delivery system. When you understand how to Bolus for pizza, that will actually open your mind up about bolusing for a mixed meal too, right? Because why? Because you look at a slice of pizza and you say, well, the box tells me or the pizza place told me this is 35 carbs, you Bolus for it. The food goes in your body doesn't start breaking it down right away. So your Bolus makes you low. Then you end up drinking a juice because you get so low and then all of a sudden 45 Yeah, the pizza hits you and now you're you're just you're lost because the insulin you put in was for the pizza. You didn't cover the juice because you were alone, etc, etc. And then you learn when to Bolus for pizza, right? Like when does the insulin go in versus When's the food going to hit? How do I balance these things up? This is what you're going to learn in the Pro Tip series for certain, if you go listen. And you'll also be able to see bigger picture about other meals, you'll be able to look at a plate at a mixed meal and say, Okay, this turkeys not going to hit very hard. It's five or six carbs, maybe. But here's the stuff that is going to hit me. And you just I don't know, at some point you just learn, right, Jenny, it's not a

Jennifer Smith, CDE 45:26
you do and that it kind of in. In that example, it kind of also goes back to figure out the foods that are pretty normal for you because that that base knowledge rolls over into other meals that may not be your typical, but appear to have similar enough content that you could expect to try to use your insulin the same way around this newer meal, right. Pizza as an example. On Nacho dinner, right nachos and meat, cheese and guacamole and whatever else comes on that they are all similar monsters, if you will. A burger and fries or a cheeseburger and fries, for example. They all have a lot of mixed nutrients that are going to be similar to pizza. So if you have the most experience with pizza, and your friends are like, Well, hey, let's go out for Burger night on Friday. You know, like okay, well, it's definitely high fat, just like my pizza. Let me try the pizza strategy. Right? Let's see, right?

Scott Benner 46:35
Yeah, even even you find yourself in a place where you get a burger. And then you grab a milkshake. And you probably think ice cream sugary fast, right? More, really, it's the fat in the ice cream that's gonna kill you right later later. Yeah, a whole bunch of episodes about how to Bolus for fat and protein. And that's the next part of this really, is that this whole conversation is based around carbs, because that's people's understanding that they're given. Except protein breaks down in your system and turns into glucose. And fat slows down digestion, which changes Bolus timing. There are other things to think about not just carbs, I'm gonna roll through some people statements here just so you can hear them right. I cried about never being able to eat cake again. I know it's ridiculous. But that's what got me. And now I learned how to eat up because of the pocket. Oh, I wish people would have told me about the glycemic index again. I wish people would have told me that my kids will be starving because of the way they set this up. And that's how it's going to feel. So now the kids are running around asking for food asking for food. And the parents like I'm sorry. You can't eat for three hours or we already Bolus for something you should have told me before. And all the stuff that they get messed up when these are some of these are really sad. Oh, my first couple of weeks, I thought I needed to have three hours after dinner before giving my Lantis like Ha he. So he's eating dinner right now. And at 9pm. I was leaving for work early. And this was stressing me out. So isn't that interesting, just a misunderstanding about when somebody told them to shoot this Lantus at a certain time, they get stuck in their head as a rule. And it creates all this anxiety for this person down to like they're now making meals when they don't want to have them to. To right.

Jennifer Smith, CDE 48:23
And again, there's lack of proper information given Yeah, it's your Basal insulin might be a very defined time of the day. But dosing that at that time of day doesn't go along with your whatever rule you've been giving about the dosing of the rapid insulin Yeah, at all, that they are independent.

Scott Benner 48:44
Right? This person says I wish someone would have just told me a little bit about how to visualize portions. Ah, see what to what you just said. Because apparently prior to that they were eating, what occurred to them and not, you know, they know people don't really think about it, right? Like, we don't talk about that, like a scoop of mashed potatoes is probably Oh, no. See you.

Jennifer Smith, CDE 49:08
I mean, you do you do or did a lot of assistance for Arden. She's been growing up, you could sit down at a dinner out, and you're focused on what's coming on to her plate. But when it comes to your own plate, are you also like, oh gosh, my burger? And is it about the same? No, you just start eating.

Scott Benner 49:27
I'm saving. I'm making her live forever. And I'm killing myself with this.

Jennifer Smith, CDE 49:32
There is no care for what's on your plate in portion.

Scott Benner 49:35
Right. And so that really is the I mean, listen, that's a bigger conversation, obviously. And I don't want to just say like Americans or anybody you know, like, is that we don't think about stuff like that food is plentiful in this country. Right? You don't think about like, well, I'll just have a little bit because I want to have some more for tomorrow, right? I mean, how many times you eat something you don't finish it again. You throw it the trash, you don't think twice about it there. You feel like there's always going to be more Food. So that feeling there's something about finances and food that go together, I haven't had I don't have this all worked out yet in my head. But when you can afford it, you stop thinking about it as nutrition and you start thinking about it as a thing you need. And because you can afford it, you can eat it, if that makes sense or not

Jennifer Smith, CDE 50:24
possibly and, or if you can afford it, you can do a little bit more specialty, or you can choose to do a little bit more quality, let's call it from specialty items. Whereas if you can't necessarily afford it, or you have just a budget that you really stick with, right, then what comes into the house may be very different.

Scott Benner 50:51
And I think that thought works in two different directions. Maybe if I can afford it, I can buy better food. And I can show it right? I should because I can afford it. But also the other side of it, I can afford it, so it doesn't matter. And the personal, like, the thing I can say is that I have found myself sometimes he's like a little candy dish. And I'll sometimes take candy out of it. And I don't want it. And at first I thought like, okay, like that's a snacking function. But I also realized back when I was broke, I wouldn't have touched it. Because the candy would have been so special. It wouldn't it was, it's almost like a favorite. It's almost like, I never missed the Charlie Brown Halloween special because it only came on once. And if I missed it, it was gone. But now I could stream it anywhere I want. And so I can just grab it whenever and the food almost falls into that category. Sometimes I can afford it. And it's here. And I stopped thinking about it as nutrition. And I just sort of I think about it as a possession almost right. That makes it

Jennifer Smith, CDE 51:54
does Yeah. You know, the other day I was I was chatting with somebody and they're like, Well, what would you have done if you wouldn't have gone this route of like, nutrition and diabetes education and whatever. And I said, you know, I, I have a very big health connection. And I said, I think I probably would have gone into the realm of educating on school information, that's health specific, to start with educating from kindergarten forward, each year builds on itself with what the kids learn in terms of their health and what they put in their body and exercise and how that builds into an adult healthy level of living, right. I mean, my, my little guy the other day, we've made a stoplight thing for our pantry. It's got a red, yellow and green light on it. He made it and we put it in there. And he knows the green foods, he can have those. As long as he's hungry. He doesn't really have to ask much about them. The yellow foods he needs to ask about and the red foods are absolutely I mean, they're not even typically in there, or they're very much on the top shelf. But it's a good way to start educating on a very early level of these foods we can go to because they're really good. They serve our body these foods, they don't need as much of them. They're still good. Or we don't really need them as often. And then, you know, but if we did more of that,

Scott Benner 53:26
right? And then it would work like the chicken nuggets with my son. Yeah, eventually his palate would just desire something that was better for him. Right? Yeah. Jane, do you have a minute or do you have to go? Yeah, I've got a minute, just unroll through a couple of things here. It would have been nice if somebody would have told me the difference between a correction Bolus and an insulin to carb ratio. They didn't understand that. That one person said that they gave me a Basal Bolus doses just excuse me, they set up Basal and Bolus dosages for my kid, but never asked about their physiological activity. And the kid was a super aggressive like active person. And so the kids always falling always falling. And of course, the mom is so new to it. She never puts two and two together. Just thinks this is what diabetes is. My kids got a thing now where his blood sugar's low all the time, right? Because

Jennifer Smith, CDE 54:19
there's no explanation to why it's happening. Right? You know it Yeah,

Scott Benner 54:23
yeah. So then she comes online and learn stuff and and then puts two to two, two and two together on her own and figures it out. The last thing was, I said I was gonna go back to something.

Jennifer Smith, CDE 54:37
Oh, yes. I don't know what it was because you

Scott Benner 54:40
didn't know I haven't. wrapping my head back around that again. She was just talking about that prior to insulin. Her whole understanding of medications was in pill form. And somehow that that predominantly made her believe that every thing was super regimented, because you take the pill in the morning with food, and then you take it again at lunch with food and everything she'd ever learned about about medications was based on timing. And then she couldn't make the insulin work the same way. And it was frustrating. I don't know why I wanted to bring that up other than,

Jennifer Smith, CDE 55:23
well, I wonder if the person is an adult who was diagnosed initially with type two diabetes?

Scott Benner 55:31
No, it's for a kid, I said, the kid, the beginning of the statement is my kid was starving, because I was trying to keep a schedule.

Jennifer Smith, CDE 55:40
So they're in again, should have been better explanation in terms of timing of insulin, it really is, because it oral oral medications, or even some other injectable medications. They all have a timeline of action, from time of giving to expected time to give the next dose, right. But they are, they are not as precise in terms of what we can then control versus insulin being much more in our realm of controlling. Because we can put it in when we know that we're going to need it based on what we're putting it in for. Even if it's for food, we do it this way. If it's for correction, we do it this way. And we might even do something else along with it. Right. So I think insulin is definitely very different than pills. Yeah. And that is that's unfortunate, too. And I don't think the doctors maybe, obviously, maybe they didn't ask enough questions in terms of understanding of medication use.

Scott Benner 56:50
It made me think about people with thyroid issues. Because when you get a thyroid issue, a doctor is going to explain to you very clearly, you have to take this medication at a certain time of day, you have to take it with, you know, an empty stomach, you have to take it not with other pills, like and or you can take it with some pills, but not all of them. And here they are. Because if you don't, your body will not take up that medication correctly. And you're going to have a deficit that will come on you slowly. And you'll just sort of your your functionality falls apart. And you don't see it happening because it happens so slowly. And still, if you go through the forums and look at people who have thyroid issues, most of their problems are because they don't take their medication correctly. correctly. Yeah, right. It's all about like, you know, I don't know, like, I just take it when I think to take it no, take it at the same time every day, because it only lasts for 24 hours. That doesn't seem to matter to them. I don't understand, I take it every day, I never forget with my vitamins, and then you look at their vitamin list. And they're taking vitamins that are blocking their absorption, the absorption of the thyroid medication. If you can think about that pill correctly, you can think about insulin correctly. And because insulin is not going to work the same in every situation. And in the beginning, that seems incredibly overwhelming. But if you I can't believe I don't I just I mean this the way I mean this, if you listen to the podcast, you'll understand those different situations eventually. And not because the podcast is magical. But because you'll hear conversations and scenarios and experiences that will eventually teach your brain like the stop and go like that your son made that. Yeah, I'm gonna do this thing, because this thing is what works for me. It's not because you've beat it into your head, or you wrote it down or you, you know, you remembered it's because it happens. You just do the thing, because it's the right way to do it. And you've heard it enough times where that's how it happens.

Jennifer Smith, CDE 59:00
Well, I think the biggest thing to within many of the episodes. Actually, I'd say all of them is something to do with a variable. Right? Yeah, it is. So if you if you pay attention and learn whether it's learning from somebody else's experience and saying, Well, I have this same sort of lifestyle, maybe I could give that a try, or that sounds like it would work better. Maybe this is why it's not working for me. Right?

Scott Benner 59:29
Well, you know that you said that. I skipped over a statement from a person here who said I wish someone would have just told me that breakfast will have a different impact every day. Even if I eat exactly the same thing, and I thought I don't want to go through that because that's not really true. It feels like that. Because that's what you see. You see the I put the insulin and at this time they ate the same food and then something different happened. But you don't see how much insulin did they have over Night. Is this a moment where there is a growth spurt or there's not a growth spurt? Is my period happening? Is my period not happening have less I very active yesterday or very sedentary? All of those variables. People who ask questions like that in the beginning, they don't see that the truth is, is that the meal and the food that didn't change something else change and you don't realize it, maybe you're on a prop and you're at the end of a pump site and it's going bad. Or,

Jennifer Smith, CDE 1:00:27
or maybe you're on an algorithm driven pump. And because settings aren't quite navigated appropriately, the system is doing one thing, some mornings giving you a load of insulin getting you ready. And so your aftermath of breakfast looks a lot better, right versus taking away. And now you're left with, you know, this deficit of insulin and then things look the opposite of what you really wanted.

Scott Benner 1:00:47
Yes, there are so many variables, yes. And the only way to learn them is to live through them. And to not put yourself in that exact mind set of that question, which is why I didn't ask that question out loud. Because I don't want people to think that I don't want them to think that diabetes just magically happens to them. Because,

Jennifer Smith, CDE 1:01:08
yes, there's nothing magical about right.

Scott Benner 1:01:12
It's all pretty, it all happens for a reason. The reasons are hard to see. And again, you keep listening to people's conversations and they say something and finally, like it pops in your head, you go oh my god, and then you relate it to something in your own life. And before you know it. That's another thing you've got in your tool belt that you don't have to wonder about ever again because it's just there when you reach for it. So anyway, I thought this is a great conversation. I appreciate you. Absolutely. Thank you. A huge thanks to you all for listening and to Jenny for coming on the show. I'd also like to thank in pen from Medtronic diabetes and remind you to go to ink pen today.com Us med.com forward slash juice box or 888-721-1514 Get your free benefits check today. Don't forget the Contour Next One blood glucose meter is available at contour next one.com forward slash juice box to get the glucagon that my daughter carries go to G vote glucagon.com forward slash juice box Omni pod five. Are you interested where the Omni pod dash doesn't matter which one you want? You get them@omnipod.com forward slash juice box and get the Dexcom G six continuous glucose monitor@dexcom.com forward slash juice box. I appreciate you guys putting up with all that today. I want to remind you that there are more bold beginnings episodes in your audio app. And they're also available at juicebox podcast.com diabetes pro tip.com. And at the private Facebook group Juicebox Podcast type one diabetes. The bold beginnings episodes begin at episode 698 Defining bold beginnings. Then at 702. honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus And today's episode, carbs. There are more coming, check them out. There'll be there in your audio apps on Friday for subscribers. They just pop up if you're a subscriber, a subscriber or a follower, by the way, in whatever app you're listening in. It'll just magically be there. So subscribe and follow, follow and subscribe. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.